amandas08
New
We have a team of AWV nurses who complete our Medicare Wellness Exams instead of a provider. Are the RNs allowed to add the charge of G0136 if they had the patient complete a SDOH assessment and found positive findings?
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Wiki G0136- Admin of SDOH assessment
- Thread starter amandas08
- Start date
vidraj
Guru
Hi Amanda, I think you can bill it.
With reference to this article on the FAQS: https://www.cms.gov/files/document/health-related-social-needs-faq.pdf
Who can perform the SDOH risk assessment?
a. The SDOH risk assessment can be performed by the treating physician or otherpractitioner (NPs, CNSs, CNMs, PAs), or by auxiliary personnel under the generalsupervision of the billing practitioner incident to their professional services.
I also found this information below in the same link above.
Is HCPCS code G0136 intended to be used with all Medicare patients, or just when a physician orpractitioner determines it is relevant for the patient?
a. The SDOH risk assessment is intended to be used when a practitioner has reason to believe there are unmet SDOH needs that could interfere with the practitioner's diagnosisand treatment of a condition or illness. HCPCS code G0136 is not designed for routinescreening. Instead, it is an assessment of one or more known or suspected SDOH needs that may interfere with the practitioners' diagnosis or treatment of the patient.
I have a follow up question for you. You mentioned " found positive findings". We have a few encounters where the SDOH form is completely negative and I am stuck with choosing a diagnosis and I came to the forum get some help on it!
So do you perform this on all patients or how do you determine the diagnosis?
With reference to this article on the FAQS: https://www.cms.gov/files/document/health-related-social-needs-faq.pdf
Who can perform the SDOH risk assessment?
a. The SDOH risk assessment can be performed by the treating physician or otherpractitioner (NPs, CNSs, CNMs, PAs), or by auxiliary personnel under the generalsupervision of the billing practitioner incident to their professional services.
I also found this information below in the same link above.
Is HCPCS code G0136 intended to be used with all Medicare patients, or just when a physician orpractitioner determines it is relevant for the patient?
a. The SDOH risk assessment is intended to be used when a practitioner has reason to believe there are unmet SDOH needs that could interfere with the practitioner's diagnosisand treatment of a condition or illness. HCPCS code G0136 is not designed for routinescreening. Instead, it is an assessment of one or more known or suspected SDOH needs that may interfere with the practitioners' diagnosis or treatment of the patient.
I have a follow up question for you. You mentioned " found positive findings". We have a few encounters where the SDOH form is completely negative and I am stuck with choosing a diagnosis and I came to the forum get some help on it!
So do you perform this on all patients or how do you determine the diagnosis?
You should not be performing this on all patients. This should only be performed when there is reason to believe that a specific patient may have unmet social needs.
If the results are negative, you do not bill G0136.
Terry Fletcher has a great article that you might find helpful to read: https://www.terryfletcher.net/2024/04/06/reporting-sdoh-g0136-in-compliance/
vidraj
Guru
Thank you for sharign this article. Exactly what I was looking for to eductae the providers. You are the best 