Home Health & Hospice Week

Tip: Docs can use a 'cheat sheet' to make CPO documentation easier.

Physicians may be more willing to refer patients to home care when they feel they are getting fairly reimbursed for their time spent on the patient's care. Here's how to help docs start getting paid for care plan oversight with a solid understanding of how and when to report G0179-G0180 and 99374-99378.

Suppose a physician spends 40 minutes setting up a home health plan of care for an elderly diabetic patient who falls outside her home and sprains her right wrist and right ankle with multiple abrasions of the right lower leg. Due to her wrist injury, she cannot ambulate with crutches or a walker, so she is confined to a wheelchair while her injuries heal. She requires home care. Currently, a physician may be writing off the 40 minutes as non-billable time -- and in the process, forfeiting about $80 in CPO services.

Physicians supervising home care can often recoup payment for their time by accessing CPO codes G0179-G0180 for Medicare and 99374-99380 for private payers. Reimbursement for these codes is on par with some of the higher-level E/M codes, so if the physician's documentation supports it, she should charge for CPO.

But because auditors have scrutinized CPO services in recent years, docs may be gun shy about billing the service. As long as a physician's CPO documentation is airtight, he should have no trouble getting paid.

CPO services are time-based E/M services that include many tasks doctors regularly perform for the long-term management of home health agency and hospice patients under their care.

Crucial: By now, physicians should know that effective Jan. 1, 2011, docs (or NPPs) who order home care must examine the patient during a face-to-face visit. (An exception occurs when a facility-based physician can perform the F2F while the community doctor signs the POC.)

Help Docs Get To Know These Codes

Although preauthorization is sometimes required, many payers will recognize these codes. Remember that Medicare accepts only G0179-G0180 for CPO, while private payers usually require the 99374 series.

First, codes for certification don't have any time or particular documentation requirements:

G0179 -- Physician recertification 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 recertification period

G0180 -- Physician certification ... including review of reports of patient status ... to affirm the initial implementation of the plan of care ...

The CPO codes include:

G0181 -- Physician supervision of a patient receiving Medicare-covered services provided by a participating home health agency ...

G0182 -- Physician supervision of a patient under a Medicare-approved hospice (patient not present)-requiring complex and multidisciplinary care modalities...

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 a hospice