Orthopedic Coding Alert

Documentation is key for care plan oversight reimbursement Don't let carriers undervalue your physician's care plan oversight (CPO) services: Start getting paid for CPO with a solid understanding of how and when to report 99374-99380 and G0179-G0180.
 
Suppose your orthopedist spends 40 minutes setting up a home-health plan of care for an elderly diabetic patient who falls outside of her home and sprains her right wrist and right ankle with multiple abrasions of the right lower leg. Due to her wrist injury, she cannot ambulate with crutches or a walker, so she is confined to a wheelchair while her injuries heal. She requires home care for assistance with activities of daily living, hygiene, and wound care. You write off the 40 minutes as nonbillable time - and in the process, you forfeit about $80 in care plan oversight services.
 
Physicians supervising home healthcare can often recoup payment for their time by accessing CPO codes 99374-99380 for private payers, and G0179-G0180 for Medicare. Reimbursement for these codes is on par with some of the higher-level E/M codes, so if your documentation supports it, you should charge for CPO. But because the OIG intends to scrutinize CPO services in 2004, it's more important than ever to ensure that your CPO documentation is airtight. Face-to-Face Time Not Required CPO services are time-based, non-face-to-face E/M services that include many tasks that orthopedists regularly perform for the long-term management of home-health agency, hospice or nursing-facility patients under their care. Orthopedists might provide such services for spinal injury patients who are wheelchair-bound or accident victims recovering from multiple traumatic injuries.
 
Although preauthorization is sometimes required, many payers will recognize these codes. Remember that Medicare only accepts G0179-G0180 for CPO, while private payers usually require the 99374 series. The CPO codes include:
 
G0179 - Physician recertification 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 recertification period
  G0180 - Physician certification ... including review of reports of patient status ... to affirm the initial implementation of the plan of care ...
  G0181 - Physician supervision of a patient receiving Medicare-covered services provided by a participating home health agency ...
  G0182 - Physician supervision of a patient under a Medicare-approved hospice (patient not present)
 requiring complex and multidisciplinary care modalities...
    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) requiring complex and multidisci-
 plinary care modalities involving regular physician development and/or revision of care plans, review [...]