Oncology & Hematology Coding Alert

Reporting G0182 could earn you $135 a claim

Are you allowing insurers to undervalue your oncologist's care plan oversight (CPO) services? Keep tabs on your CPO reimbursement by following our experts' advice on how and when to report G0179-G0182 and 99374-99380.

1. Use Different Codes for Medicare, Private Payers

Although Medicare and private payers usually pay only for face-to-face services, you can report your oncologist's indirect care of CPO patients and get reimbursed. CPO services are time-based, indirect E/M services that include many tasks that physicians regularly perform for the long-term management of home health agency, hospice or nursing facility patients under their care.

You should bill for the time the physician spent treating the patient, but make sure the physician documents the time so you can report the appropriate codes, says Bo Gamble, an administrator at Southeastern Medical Oncology Center in Goldsboro, N.C.

That's because all CPO code descriptors for G0179-G0182 and 99374-99380 include physician supervision.

Problem: Your oncologist spends 40 minutes developing a plan of care, reviewing the patient's status, and discussing treatment with other health professionals for a patient with prostate cancer (185, Malignant neoplasm of prostate). Your physician writes off the 40 minutes as nonbillable time -- and forfeits about $135 in CPO services.

Solution: Using the example above, if your physician oversees a Medicare hospice patient, you could report G0182 (Physician supervision of a patient under a Medicare-approved hospice [patient not present] ... within a calendar month, 30 minutes or more). Nationally, Medicare pays $135 for the code. 

For private payers, you should assign 99378 (Physician supervision of a hospice patient [patient not present]...within a calendar month; 30 minutes or more). When billing CPO services, you can't submit CPT codes 99374-99380 to Medicare, which accepts only G0179-G0182 for CPO.

2. Understand Your Physician's Role

Remember that physicians who bill CPO must have directly cared for a CPO patient within the six months immediately preceding the first reported CPO claim. For example, if the physician billed for initial hospital care (99221, Initial hospital care, per day, for the evaluation and management of a patient ...) three months before the CPO services, you could submit G0179-G0182 to Medicare.

For home health services, report G0181 (Physician supervision of a patient receiving Medicare-covered services provided by a participating home health agency ... within a calendar month, 30 minutes or more). Private payers will accept CPT's home health code 99374 (... 15-29 minutes).

3. Keep the Certification Rules Straight

Medicare also requires that physicians certify and recertify all patients receiving CPO services under the care of a home health agency.

To report these recertification services, you should use either G0179 (Physician re-certification for Medicare-covered home health services under a home health plan of care [patient not present] ... per re-certification period) or G0180 (Physician certification for Medicare-covered home health services ... per certification period).

Note: You can assign certification code G0180 only when a physician has not provided Medicare-covered home health services for at least 60 days. And you should use the recertification code G0179 once every 60 days, unless a patient requires a new plan of care.

4. Meet Medicare's CPO Time Requirements

The physician must spend at least 30 minutes in a calendar month performing CPO for you to report G0181 or G0182 to Medicare, coding experts say.

Documentation is crucial: The physician should record the time he spent reviewing x-ray films and lab results and any other services that involve the physician's treatment.

To ensure the physician is aware of the documentation requirements, be sure you have good communication with him. You can't include the physician's professional discussions or chart reviews in the CPO time requirements if you don't know about them, Gamble says.

But remember, you cannot combine a week from last month with the first two weeks of this month to arrive at the desired billable time, says Marcella Bucknam, CPC, HIM program coordinator at Clarkson College in Omaha, Neb.

Tip: Staple a "cheat sheet" to the forms that your home health agencies send to you. On the forms, the physician should document the time spent on the patient's CPO.

Physician time is a primary reason Medicare won't reimburse for CPT's 99374 (Physician supervision of a patient under care of home health agency ... within a calendar month; 15-29 minutes), which covers between 15 and 29 minutes of CPO services.

5. Don't Include Travel Time in CPO

Unfortunately, you cannot report all of your oncologist's home health certification services as CPO.

For instance, you can't include the physician's traveling time in the minutes of CPO services. Helpful: You should bill only for services that require the physician's skills.

Never report the following services as CPO, according to the Medicare Carriers Manual, section 15513: