Internal Medicine Coding Alert

Question: Hospice caregivers call an internist regularly about patient issues such as adjustments to pain medication, the need to start intravenous fluids, and requests for a variety of other prescriptions and orders. The physician logs 90 minutes of phone calls as well as discussions and treatment recommendations. How should we report this?

Florida Subscriber 

Answer: To report your internist's services, you should use care-plan oversight code 99378 (Physician supervision of a hospice patient [patient not present] requiring complex and multidisciplinary care modalities ...; 30 minutes or more) for a private-pay patient and HCPCS level II code G0182 (Physician supervision of a hospice patient ... 30 minutes or more) for a Medicare patient.
 
CPT and Medicare base CPO coding on the patient's location. Codes 99374-99375 (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] ...) and G0181 are for patients under the care of a home health agency. For hospice care patients, as in your example, you should report 99377-99378 or G0182 (... Medicare-approved hospice ...).

 - Answers for You Be the Coder and Reader Questions were reviewed by Kathy Pride, CPC, CCS-P, a coding consultant for QuadraMed in Port St. Lucie, Fla.; and Bruce Rappoport MD, CPC, a board-certified internist who works with physicians on compliance, documentation, coding and quality issues for RCH Healthcare Advisors LLC, a Fort Lauderdale, Fla.-based healthcare consulting company.