Ob-Gyn Coding Alert

Question: I have an ob-gyn that is filling out G0180, G0181, and G0179 on a daily, weekly, monthly basis for a 25 years old patient who has a commercial plan. Can we bill these codes to a payer other than Medicare? I cannot find any proof to show him other than the HCPCS book that states Medicare, but now he wants to at least bill the G0181 plan of care. What should I do?

Codify Subscriber

Answer: Your ob-gyn is heading for an audit, and he will not enjoy the result. 

Codes G0180 (Physician 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 patients needs, per certification period), 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 modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of laboratory and other studies, communication [including telephone calls] with other health care professionals involved in the patient’s care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month, 30 minutes or more), and 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 patients needs, per re-certification period) are Medicare patient only codes. 

For Medicare patients, you may not bill G0179 and G0180 on the same date of service. Remember, Medicare requires G0179 or G0180 before they will cover home health services. 

The CPT^® codes for supervision of home health care with patient not present are 99339- 99380. Be sure you read the guidelines carefully. You won’t find any CPT^® equivalent to G0179 or G0180, because commercial payers do not run Medicare-approved home health programs -- nor do they usually require (or pay separately for) a physician’s order that the patient needs this care.