Home Forums Discussions Coding and Billing Care Plan Oversight billing

As a family doc I always have a dozen or so patients receiving VNA or hospice services. They are home-bound and can't get to the office. I do some house calls which we bill, but we've never billed for all the time we spend handling phone calls and paperwork related to these patients. CMS apparently has some codes for billing "Care Plan Oversight": G0180, G0179, G0181, and G0182. Does anyone have any experience using these codes? Have you worked out a system for tracking time spent monthly in AC?

A while ago I went on the Medicare site and thought that the cert is the first code then the recert is for every 60? days and we have that form we have to sign and fill out.
You have to document time - I thought it had to be a total of 30 minutes per plan to get reimbursed. We chart - 5 minutes spent reviewing chart etc. as a message in the ecounter when we submitt for billing wiht about 5 etc of those notes throght out the billing period saved to the record. Not sure if this is correct or if we even got paid on it. We will know better with the new biller and in house system we just started effective 1/1/15.

Be aware of the transititon of care codes, i heard, you can not submitt unitl 60 days have passed post discharge date(even though it is for either a 7 or 14 day time frame).
Just another nonsensical medical billing pearl docs have to waitt to get paid on or face a denial.

You should be using all the codes and try to use the new CCM (chronic care management) code as well. This is your best bet at this time for getting paid for non face-to-face services

G0180 -- Initial certification of Home Health form: This is simply reviewing, attesting, and signing off on the home health form. There is no reason you should not be charging for this

G0179 -- Recertification of Home Health: This is same as above on a recertification form after the initial 60 day certification as expired

G0181 -- Care plan oversight: This is billed when you spend 30 minutes or more on the phone with home health, reviewing labs, coordinating care, etc. It is only for patients enrolled in home health services. You do need to have a little tally sheet handy for keeping track of the minutes. However, if you keep track (think like a lawyer!) then you can bill

G0182 -- This is same as G0181 but for a hospice patient. You will need to use a GV or GW modifier for this code provided you are not under a payment contract with the hospice (if you are, you cannot bill separately for this service)

99495 -- Transitional care management moderate (TCM): Everyone should bill for these when a medicare patient leaves the hospital or nursing home. There needs to be a phone call from your staff to the patient within 48 hours and a follow up within 14 days. The bill is submitted 31 days after the discharge. This extra work garners the equivalent of an additional level 3 visit on top of your regular charge.

99496 -- TCM code high: Same as above but higher acuity so patient needs to be seen within 7 days of discharge. Garners about an extra level 4 payment for this work.

Chronic Care Management codes (CCM) -- if you can achieve all the components of this, you can get paid about $42 for any time you or your staff spends 20 minutes on the phone or otherwise coordinating care. Requirements are moderately difficult, especially the requirement that care plans must be created and shared electronically. More information is available in this excellent article in ACP Internist

http://www.acpinternist.org/archives/2015/01/coding.htm

Thanks! Great info.

99495 -- Transitional care management moderate

I have found this code very difficult to bill. It cant be submitted till 30 days after discharge. The patient is not allowed to die in that time. If the patient is readmitted this throws a monkey wrench into the sitatuion. No home health certifications can be billed during this period. Although extra office visits other than the one included in the code are supposedly allowed to be paid I did have some denied.

Because the majority of my patients do indeed get home health post hospital discharge and home health certification is billed by me , I gave up on 99495.