Oncology & Hematology Coding Alert

When a patient is referred to a home-health agency or hospice, the oncologist is not excluded from having a say in treatment, and all billing opportunities are not lost. A physician whose patient is being cared for in a home-health or hospice setting can code several services related to case management, including G0181 and G0182 for care plan oversight (CPO). (See definitions below.)
 
Oncology physicians often monitor their patients' progress after a referral to a home-health agency or hospice. They may take part in interdisciplinary team meetings, hold telephone conversations with other healthcare professionals and recertify patients for continued care under home health.
 
These services may represent a big part of a physician's time and may deserve payment. The problem is there are a number of case-management codes to choose from, most of which are not covered under Medicare or are no longer used.

 
At first, 99361 (medical conference) seems to be an accurate and appropriate code to report a meeting with home-health workers or hospice interdisciplinary team members. In CPT 2001 it is described as a "medical conference by a physician with an interdisciplinary team of health professionals or representatives of community agencies to coordinate activities of patient care."
 
According to the American Society of Clinical Oncology's Professional Practice and Policy Department, 99361 is not a separately payable item and is always considered part of E/M services.
 
In that same vein, telephone conferences, 99371-99373 (telephone call), for coordinating care seem appropriate. According to the CPT, 99371-99373 describe a telephone call by a physician to a patient or healthcare professional for medical management or coordinating medical management. However, Medicare policy excludes payment of these codes.
 
While it seems that the codes that best describe the case-management efforts of oncologists lead to no reimbursement, CPO codes encompass the services described in 99361 and 99371-99373. And, they are reimbursable, says Barbara Austin, RN, MN, director of clinical development for Visiting Nurse Health System in Atlanta, a home-health agency and hospice. The organization provides its referring physicians, including oncologists, with reimbursement advice to help physicians get paid for their home-health and hospice-related services.
 
CMS released two new codes this year to replace those in CPT 2000. Rather than using 99374-99375 (physician supervision) for home health and 99377 (physician supervision) for hospice, the following are correct:
 
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 healthcare 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.
 
G0182 -- physician supervision of a patient under a Medicare-approved hospice [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, communications [including telephone calls] with other healthcare 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.

 
Although the codes are new, determining time spent on care plan oversight is the same. Practices must document each minute the physician spends performing CPO services in a 30-day period. For every 30 minutes spent doing CPO each month, oncology practices should report either G0181 or G0182.
 
The definitions for both home health and hospice care plan oversight point to seven services that can be used to tally CPO -- review of charts, reports, treatment plans and other test results; telephone calls (excluding time spent on hold) to hospice or home-health representatives; team conferences; discussions with pharmacist about pharmaceutical therapies; medical decision-making; coordination of services; and documenting the services provided in the patient chart.
 
Care plan oversight provided by a nurse, nurse practitioner, physician assistant, clinical nurse specialist or other staff is not reimbursable, Austin says. CPO codes are reserved for services provided directly by the physician. 
 
Physician time spent calling in prescriptions to a pharmacy, retrieving a chart, or travel time are not considered eligible and cannot be used to sum up time spent performing CPO. These are all included in the E/M service.

 
In addition to new CPO codes, oncology physicians who refer their patients to homecare should bill Medicare for certifying and recertifying services provided by a a home-health agency. The new codes were added to encourage more physician involvement in their patients' care.
 
Code G0179 (MD recertification, HAA patient) is used to recertify a patient who has received home-health services for at least 60 days, or one certification period.  Code G0180 (physician certification services for Medicare-covered services provided by a participating home-health agency [patient not present], including review of initial or subsequent reports of patient status, review of patient's responses to Oasis assessment instrument, contact with the home-health agency to ascertain the initial implementation plan of care, and documentation in the patient's office record, per certification period) applies to patients who have not received Medicare-covered home-health services for at least 60 days. The national reimbursement average for G0180 is $73, and the national reimbursement average for G0180 is $53. These amounts vary by region.