Orthopedic Coding Alert

Question: Does anyone bill Medicare for completion of paperwork such as renewal or updates of physical therapy or home health equipment (like a wheelchair)?

Arizona Subscriber
 
 
Answer: For 2001, CMS introduced two new codes for the certification (G0180) and recertification (G0179) of home healthcare plans. The full descriptions for each code are G0179, MD recertification, hepatitis associated antigen patient; and 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 patients responses to the Oasis assessment instrument, contact with the home health agency to ascertain the initial implementation plan of care, and documentation in the patients office record, precertification period.
 
CMS also introduced a new code for care plan oversight, 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 or other studies, communication (including telephone calls) with other health care professionals involved in the patients care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month, 30 minutes or more. HCPCS codes G0179 and G0180 are only to be reported by physicians who are permitted to certify that a patient requires home health services in accordance with specific sections of the Social Security Act.
 
HCPCS code G0181 was created in response to revisions made to the CPT codes for care plan oversight (99375 and 99378) when new language was added that made the codes inconsistent with current Medicare policy. These codes are not to be used for the completion of an occasional certificate of medical necessity. Before reporting any of these codes, you should determine whether the service(s) your physician is providing in reviewing and completing certification forms meets the criteria associated with them. Start with HCFA Program Memorandum B-00-65, published in November 2000 and review sections 1814(a)(2)(C) and 1835(a)(2)(A) of the Social Security Act.