Eli's Hospice Insider

Published on Thu Mar 23, 2017 PDF

To get your skilled nursing coding right, you’ll need to ignore part of the description for new G codes that took effect Jan. 1.

The problem: “There seems to be some confusion among hospice providers, which is causing claims to go to the return to provider (RTP) status/location (T B9997) with reason code 31428 due to incorrect HCPCS code being submitted,” reports HHH Medicare Administrative Contractor CGS. The description for G0493 reads “Skilled services of a registered nurse (RN) for the observation and assessment of the patient’s condition, each 15 minutes” and G0494 is the same for an LPN. Likewise, G0495 reads “Skilled services of a registered nurse (RN), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes” and G0496 is the same for an LPN.

Even though those descriptions mention hospice, “there have been no instruction issued by the Centers for Medicare & Medicaid Services (CMS) allowing hospices to submit these G codes,” CGS stresses. “When a hospice reports any of the above G codes, their claim will be sent to RTP with reason code 31428 (invalid HCPCS code for the revenue code being billed).”

The solution: Bill your claims with the correct nursing G code for the date the service was furnished. CGS offers charts of valid G codes by date and provider type at http://cgsmedicare.com/hhh/pubs/news/2017/0217/cope2235.html.