Primary Care Coding Alert

Question: After reviewing a home-bound Medicare patient's status, my family physician (FP) creates a plan of care. He conveys his orders to a home health agency and verifies that the agency complies with his certification plan. How should I report the service?

Michigan Subscriber

Answer: When an FP initially prescribes Medicare-covered home health agency care, such as nursing and limited housekeeping services to homebound patients, you should report G0180 (Physician certification 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 certification period).

Consider a typical certification plan for an 80-year-old man with chronic obstructive pulmonary disease who is recovering from gall bladder surgery. Because of the potential for complications, the FP monitoring the patient's recovery orders biweekly nurse visits from a home health agency for the first four weeks, and weekly thereafter. The FP asks the nurse to assess the prescribed medications' effect; the patient's gastrointestinal, nutrition and hydration status; and the incision's healing rate. The physician dictates the orders, including physical therapy, bathing and light housekeeping to the agency by telephone. And the FP creates goals for the patient and expectations for the patient's progress.

As long as the patient has not received home health services for 60 days or longer, you should report the above scenario with G0180. If the FP extends the plan beyond 60 days, you should assign G0179 (MD recertification, HHA patient).