# G0179 or G0180 - OUR Initial Cert, Not Patient's



## suemt (May 26, 2011)

Which code should I use?  The patient is new to our practice, hence it is our first/initial certification, but the patient has been certified before so it is a recertification for the patient.  

Thanks in advance for your replies!

Sue


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## jbrashear (May 26, 2011)

*Recertification*

I'm going to say recertification. The rules for HH cert. would trump the new patient rule, I think.


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## suemt (May 26, 2011)

Thanks, jbrashear.  That is what I'm thinking, but there is a contradictory opinion here and I always like to get a second opinion!


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## JanSchell911 (May 29, 2011)

I would bill a recert, also.  As I understand it, there are additional guidelines this year.  Specifically, the doctor must have had a face to face visit with the patient within 90 days to the certification.


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## jbrashear (May 31, 2011)

*Recert*



JanSchell911 said:


> I would bill a recert, also.  As I understand it, there are additional guidelines this year.  Specifically, the doctor must have had a face to face visit with the patient within 90 days to the certification.



That's exactly right. The rules for documentation got a little more strict this year. And if you think about it, we are trying to apply E/M rules to a non E/M service, which I think strengthens the argument for a recert. The only other detail I would even want to point out is that if a patient has gone 90 days+ without having a recert done, then can't you bill an initial certification even if it is for the same dx? I haven't been able to find my info on it for some reason. 

Let me know what you think.

Janice Brashear, CPC


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## suemt (Jun 6, 2011)

The doc sees the patients at least once every 90 days.  Usually more than that.  

As for a new 'initial' cert, good question.  Instinctively I'd say lack of a recert doesn't justify a new initial cert, but unfortunately you can't go on instinct today.  I'm not sure how they are doing it, but it is certainly something to look into.


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