Use Condition Code G0 to Ensure Payment

Coders need to know when to use the G-zero (G0) condition code and understand what the 72-hour rule is when coding for a patient who has more than one visit to the same facility on the same day.

Billing for multiple, unrelated visits on the same day is an issue that comes up quite a bit, explains Caral Edelberg, CPC, CCS-P, president of Medical Management Resources, an emergency medicine coding company in Jacksonville, Fla. Were seeing more of this is our outpatient areas and the emergency department (ED).

When to Use the G0 Condition Code

The condition code G0 is assigned through your billing system. By definition, you should use G0 when two separate and distinct visits are provided on the same date of service in the same revenue center. It basically identifies multiple, distinct visits on the same calendar day as appropriate and allows each to be paid separately. According to the HCFA edits, these have to be distinct and independent medical visits to the same revenue center within the same calendar day, Edelberg explains. So you could not bill, for example, two evaluation and management (E/M) levels in the ED on one day without the G0 condition code assigned in the appropriate field on their claim form.

Condition codes allow coders to identify exceptions to the rules when appropriate. Although edits prevent payment for multiple, related visits on the same day, you can use G0 to indicate you should be paid for two or more distinct and unrelated patient visits made within one revenue center on the same day. When multiple visits occur, you are also required to enter the number of visits in the units field of the UB92 claim form.

G0 is a condition code that explains that something unusual has occurred outside the normal billing process. This tells the payer that the condition code G0 is being used because two separate visits are provided on the same day of service in the same facility. For example, if a patient comes into the facility for a possible allergic reaction in the morning and then returns in the evening for a laceration, you bill the level of service with the G0 condition code because these are two unrelated visits and you want to be paid for each as a separate encounter or service.

Hospital staff responsible for billing this G0 condition code must be familiar with its use because without it, there will be visits that may not get reimbursed, Edelberg explains. Please understand that when you use the G0, its assumed that the visits are distinct and independent. So each would have to be for a separate problem, separate diagnosis or separate complaint. Hospitals must report [...]

- Published on 2000-12-01