Neurosurgery Coding Alert

Question: I am confused about how to code care plan oversight (CPO) claims. Can you explain the basics of CPO coding?

Ohio Subscriber
 
Answer: When coding CPO, make sure you choose the codes based on the payer; private payers have much different CPO reporting guidelines than Medicare.

Private payers: Generally, private insurers will acceptthese CPT codes, grouped by time and place of service:

- 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) ... 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.

So if the physician spends 23 minutes on CPO with a privately insured patient in a hospice, you-d report 99377 for the encounter.

Medicare: You-ll need to dip into the agency's G codes to properly report CPO. For Medicare patients, choose from these codes for your physician's CPO; they are grouped solely by place of service:

- 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

- G0180 -- Physician certification ...

- G0181 -- Physician supervision of a patient receiving Medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care ... 30 minutes or more

- G0182 -- Physician supervision of a patient under a Medicare-approved hospice ... 
 
So if the neurosurgeon performs 42 minutes of CPO for a Medicare-insured patient in a home health agency, you-d report G0181.

Remember: In order to file a CPO service to a Medicare payer, the surgeon must spend at least 30 minutes total during the month dealing with the patient's care. With private payers, the surgeon must spend only 15 minutes with the patient to qualify for the CPO codes.

Clinical and coding expertise for You Be the Coder and Reader Questions provided by Eric Sandhusen, CHC, CPC, MPH, director of compliance for the Columbia University department of surgery.