General Surgery Coding Alert

Physicians supervising complex and multispecialty patient care can often recoup payment for their time by accessing care plan oversight (CPO) codes 99374-99380. Documentation is crucial when reporting 99374-99380, however, and lack of thorough and efficient records can lead to even more unpaid effort. What It Is CPO services are time-based, non face-to-face E/M services that include many tasks physicians regularly perform for the long-term management of home health agency, hospice or nursing facility patients under their care. Surgeons might provide such services for transplant patients undergoing immunosuppression therapy or vascular patients on long-term anticoagulant therapy.

"Reimbursement is quite good for these codes," says Shirley Fullerton, CPC, CPC-H, CMBS, academic director of the Medical Association of Billers. "You shouldn't be giving your time away. You should be billing for these services." Although preauthorization is sometimes required (check with your individual insurer), many payers will recognize these codes. The CPT descriptors for CPO (revised for 2002) summarize many of the services included: 99374 Physician supervision of a patient under care of home health agency (patient not present) in home, domiciliary or equivalent environment (e.g., Alzheimer's facility) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of related laboratory and other studies, communication (including telephone calls) for purposes of assessment or care decisions with healthcare professional(s), family member(s), surrogate decision maker(s) (e.g., legal guardian) and/or key caregiver(s) involved in patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month; 15-29 minutes
99375 30 minutes or more
99377 Physician supervision of hospice patient ...; 15-29 minutes
99378 30 minutes or more
99379 Physician supervision of a nursing facility patient ...; 15-29 minutes
99380 30 minutes or more. Other activities that may be counted toward CPO but that are not specifically mentioned in the CPT descriptors include time devoted to medical decision-making, coordination of services to be performed by the physician (if the coordination of activities requires physician skill) and documenting services provided, i.e., describing services in the patient's chart, decision-making performed, and time spent. And What It Isn't You cannot report all physician services as CPO, however, even if they involve much time and effort. "Not everything that we think should be countable is countable," Fullerton warns. "You cannot count what does not require a physician to perform. The activities must require a physician's skill, and anything that does not meaningfully contribute to the treatment of the illness or the injury does not count."

According to the Medicare Carriers Manual (MCM), section 15513, other service not part of CPO include: initial interpretation or review of lab/study [...]