Gastroenterology Coding Alert

Question: What codes should we report when we are certifying and recertifying plans of care for our home healthcare patients?

Arizona Subscriber

Answer: For initial certification of a home healthcare plan -- and recertification of a patient who hasn't received Medicare-covered home health services for at least 60 days -- report G0180 (Physician certification for Medicare-covered home health services under a home health plan of care [patient not present], including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial implementation of the plan of care that meets patient's needs, per certification period). G0180 will certify the patient for 60 days of home healthcare.

If you are extending a plan beyond the initial 60 days, report G0179 (Physician re-certification for Medicare-covered home health services under a home health plan of care [patient not present], including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial implementation of the plan of care that meets patient's needs, per re-certification period).

There are times when some gastroenterology patients, such as those with Crohn's disease or pancreatitis, require home healthcare to control their conditions. In January 2001, HCPCS unveiled codes especially for reporting certification and recertification services.

Warning: Don't bill these codes unless the gastroenterologist is acting as the patient's primary-care physician and has direct contact with the home healthcare agency servicing the patient. Otherwise, your office is not justified in using the codes.