Primary Care Coding Alert

Question: A family physician met with the family members of an assisted living facility patient (patient was not present) for about 17 minutes to discuss the individual's memory loss and personality change. Because we are billing the service to our Medicare carrier, my peers think we should use G0181-G0182 instead of 99374. Are they correct?


New Jersey Subscriber


Answer: You are right that Medicare requires G0181-G0182 instead of 99374-99375 or 99339-99340. But your scenario does not qualify for care plan oversight (CPO) services. You should instead include the work in the related patient/FP face-to-face E/M service.

Why: CPO codes describe the work a physician provides monthly while performing frequent complex supervision services to a patient in a home, domiciliary or rest home, including:

- regular physician care plan development and/or revision

- reviewing subsequent patient status reports

- reviewing related laboratory and other studies

- assessment or care decision communication with healthcare professional(s), family member(s), surrogate decision-maker(s) and/or key caregiver(s) involved in a patient's care

- integrating new information into the medical treatment plan and/or adjusting medical therapy.

An isolated meeting with a patient's family, as your example involves, does not qualify as -complex and multidisciplinary care modalities.- When an FP provides very low-intensity or infrequent supervision services, CPT directs you to include the work in the pre- and post-encounter work for the related service, such as an assisted living facility visit (99324-99337, Domiciliary or rest home visit for the evaluation and management of a - patient). (See CPT's care plan oversight services- introductory notes).

Incidentally, when you do report CPO services for a private-pay assisted living facility patient, you would assign new 2007 codes 99339-99340 (Individual physician supervision of a patient [patient not present] in home, domiciliary or rest home [e.g., assisted living facility] requiring complex and multidisciplinary care modalities ...), not 99374-99375 (Physician supervision of a patient under care of home health agency [patient not present] in home, domiciliary or equivalent environment -).

Codes 99374-99375 correspond with HCPCS codes G0181 and G0182, which describe the same service for a patient in a Medicare-approved hospice.