You Be the Coder:
Hospice Care
Published on Sat Jun 01, 2002
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: I have been supervising the care of a hospice patient with chronic obstructive pulmonary disease (COPD). How should I bill for this?
New Mexico Subscriber
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Answer: You should report care plan oversight (CPO) codes 99377(Physician supervision of a hospice patient [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 15-29 minutes) or 99378( 30 minutes or more) if the patient is non-Medicare. For Medicare patients who require complex, recurrent care and reside in a home health agency, use G0181(Physician supervision of a patient receiving Medicare-covered services provided by a participatient home health agency [patient not present] requiring complex and multidisciplinary care modalities involving regular physician development )or G0182 (Physician supervision of a patient under a Medicare approved hospice ) for a hospice patient.
Note: Medicare will not reimburse CPO services that take less than 30 minutes or that are performed in a nursing facility.
The key to proper reimbursement of the CPO codes is thorough documentation. There are several rules to follow to report these services:
Documentation must prove that you spent the amount of time called for in the code descriptor. For Medicare patients, you must prove that you spent 30 minutes or more to be reimbursed.
You can bill only in the month following the service you provided.
Only one physician can report CPO services for a given period of time to show that physician's single supervisory role with a particular patient. Report the Medicare provider number of the beneficiary's home health agency or hospice in item 23 of the CMS 1500 form.
Report the dates that the services were provided, as opposed to the calendar period for which the claim is submitted.
You must have provided a face-to-face E/M service to the patient within six months before the first CPO. This does not include electrocardiogram, lab services or diagnostic services.
The physician cannot have a significant financial or contractual interest in the home health agency or hospice to treat Medicare beneficiaries.
You cannot bill "incident to" the physician's service for CPO if a nonphysician practitioner treats the patient.
The physician must document which services were furnished and the date and length of time associated with them.
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