Pulmonology Coding Alert

Pulmonologists often provide care plan oversight (CPO) services to patients with lung diseases who are admitted to home healthcare. For example, patients with chronic obstructive lung disease (COPD) (496) and emphysema (ICD-9 492.0 -492.8 -) are treated effectively at home or in hospice. Patients with COPD often require multiple medications, such as diuretics to decrease edema. Pulmonary physicians also review lab test results, and they must communicate those results to home health caregivers.

Although you can bill under the CPO Services Procedures Codes, pulmonologists must document that those patients had some active, ongoing problem that required close monitoring by home health workers. They must also show that the home health workers had to consult with the pulmonologist frequently.

Susan Callaway-Stradley, CPC, CCS-P, a coding consultant and educator in North Augusta, S.C., stresses that CPO services call for impeccable documentation. You must prove that you spent 30 minutes on things you can bill for. You must also bill in the month following the service you provided, according to Medicare guidelines. If you send your bill out on Sept. 30 for services you provided in September, you wont get paid, she says.

Although there is no standard, government-approved form for tracking and reporting these cases, pulmonary practices can create their own form that is easy to use.

Billing Requirements

To bill for CPO, you obtain and submit the Medicare provider number of the beneficiarys home health agency (HHA) or hospice. Report the number in item 23 of the HCFA 1500 form. Submit the dates that the services were provided, not the calendar period the claim is being submitted for.

Callaway-Stradley emphasizes that the pulmonologist who orders home healthcare and then sees the patient at home within the same month cant use these codes. Neither can you use the codes for patients in nursing homes. When you go through the instructions from any of the Medicare carriers on these codes, these are the things that need especially careful, focused attention, she says. Care plan oversight codes provide a real opportunity to be audited.

According to Callaway-Stradley, only one-fourth of the money the government set aside for CPO was paid out last year. The probable reason is that the documentation requirements were so cumbersome that most physicians didnt complete them. I have one client who got audited for using these codes, she says. The reason for the audit was that the clients office was the only one in the area using these codes. Luckily, the clients documentation was first-rate.

HCFA Announces New Codes

HCFA has announced that effective Jan. 1, 2001, new codes will be in effect for providing supervision of home health (G0181) and hospice patients (G0182). These codes will replace 99375 [...]