Internal Medicine Coding Alert

Question: When an internist performs a recertification for a skilled nursing facility (SNF) patient, what code should I use? I use G codes for monthly home-health recertifications, but the physician recertifies SNF patients every two weeks.


Utah Subscriber


Answer: CPT and HCPCS do not offer a code for SNF patients that corresponds to home-health service recertification code 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). You should use this code when an internist changes a home-health agency patient's treatment plan.

For instance, a patient isn't meeting the goals or levels that the physician set. So the home-health agency requests the internist reevaluate the patient's plan and change her medication. For a Medicare patient, you should report G0179, which Medicare covers monthly.

The closet code to G0179 that applies to SNF patients is care plan oversight code 99379 (Physician supervision of a nursing facility patient [patient not present] 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) or 99380 (... 30 minutes or more). 
   
Problem: Medicare considers 99379-99380 bundled services. For SNF patients on private insurance, you could report non-face-to-face treatment plan documented time with 99379-99380.

Caution: When the internist instead evaluates the patient during a face-to-face service, choose between the following codes for SNF-related services. When an SNF patient requires a change in care due to a significant complication, new problem or major permanent status change, you should charge nursing facility assessment code 99302 (Evaluation and management of a new or established patient involving a nursing facility assessment ... The creation of a new medical plan of care is required ...). If the internist instead evaluates a sick patient, assign a sick visit with 99311-99313 (Subsequent nursing facility care, per day, for the evaluation and management of a new or established patient ...).