Primary Care Coding Alert

HCFA introduced two temporary (HCPCS) codes in 2001, giving family physicians (FP) an avenue for reporting and being paid for certification of home healthcare patients.

The new codes, which became effective Jan. 1, are:

G0179 MD recertification, HAA 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, per certification period.

These codes will be a great help, says Diane Farris, CPC, coding specialist for Southern Chester County Family Practice Associates in Oxford, Pa. In the past, we werent reimbursed for these services. Its good finally to see an official method for reporting them.

G0180 Reported for New Plan of Care

Code G0180 is reported when a family physician initially prescribes Medicare-covered home health agency care, which typically includes nursing, as well as limited housekeeping services to homebound patients. Physician certification encompasses creation and review of a plan of care, and initial verification that the home health agency complies with it. A family physicians review of data collected in the home health agencys patient assessment, which includes the Outcome and Assessment Information Set (OASIS), is encompassed in G0180.

Care must be provided in the patients private residence to individuals unable to transport themselves to the FPs office for visits. Patients do not need to be present when the physician develops the care plan for the home health services.

Creating a Typical Certification Plan

An 80-year-old man with chronic obstructive pulmonary disease is recovering from gall bladder surgery. Because of the potential for complications, the family physician monitoring the patients recovery feels it is appropriate to send a nurse from a home health agency to see the patient two times per week for the first four weeks, and once per week thereafter.

The FP asks the nurse to assess the effect of the medications being given, the patients gastrointestinal status, nutrition, hydration status and the healing of the incision. Physical therapy, bathing and light housekeeping are also ordered from the agency. The physician dictates the orders to the agency via the telephone. In addition, the FP creates goals for the patient and expectations for the patients progress.

Farris explains that G0180 describes initial certification for patients who have not received home health services for 60 days or longer. If a plan were extended beyond 60 days, G0179 would be assigned. According to HCFA guidelines, recertification may apply to the care plan that was previously certified or a modification of it. National payment averages are approximately $60 for certification and about $53 for recertification.

On rare occasions, G0180 may be reported more frequently if the patient starts a new episode and requires a different plan of care to start this new episode. For example, the patient described above develops lung cancer, requiring the physician to create a new care plan to cover care for the additional condition.

Form HCFA-485 May Be Used for Documentation

Although glad that HCFA has provided these new codes, Farris says family practices continue to be frustrated by documentation for these services. According to Brett Baker, third-party relations specialist at the American College of Physicians-American Society of Internal Medicine in Washington, D.C., very little direction has been provided about how to assign G0180 and G0179. Carriers have been slow to provide information because they are waiting for instructions from HCFA, he says, and information from HCFA is just trickling out.

Without clear direction from HCFA, Baker recommends that physicians document certification or recertification of the patient home healthcare plan in the medical record. The note should describe activities involved in making the decision and explain why the plan is appropriate or why the recertified plan had to be revised.

Other coding experts advise family practice coders to use form HCFA-485 (Home Health Certification and Plan of Care) for documentation. When the physician dictates the plan of care to the home health agency, the agency should transcribe that information to the form and return it for the FPs signature. The agency would keep the original form on file and give a copy to the physician. Some home health agencies may also want a duplicate of the signed copy to file with the claim for certification.

A diagnosis code must also be included on the claim. In the initial example above, coders would report cholecystitis (575.0, acute cholecystitis) as the primary diagnosis. Lung cancer could be used as a secondary diagnosis (162.8, malignant neoplasm of trachea, bronchus, and lung, other parts of bronchus or lung).

Medicare representatives have indicated that coders may report either the patients home or office as the site of service. However, many experts recommend coders use the office on claims.

When the plan of care has been certified, coordination of care with the home healthcare nurse is billed as a care plan oversight service as described by 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 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).

For more information on G0181, please review the February 2001 issue of Family Practice Coding Alert.