Neurosurgery Coding Alert

Careful documentation could earn you an extra $80

Don't let carriers undervalue your physician's care plan oversight (CPO) services: Start getting paid for CPO with a solid understanding of how and when to report 99374-99380 and G0179-G0182. Don't Give the Surgeon's Time Away Suppose the surgeon spends 40 minutes setting up a home health plan of care for a spinal surgery patient who falls during her recovery and sprains her left foot and wrist. Because the patient also has vertigo, the potential for another fall is significant, so your physician prescribes home healthcare and creates goals for the patient's progress. You write off the 40 minutes as nonbillable time - and in the process, you forfeit about $80 in care plan oversight services.

"Reimbursement is quite good for care plan oversight," says Marcella Bucknam, CPC, HIM program coordinator at Clarkson College in Omaha, Neb. "You shouldn't be giving your time away." Although insurers sometimes require preauthorization for CPO services, many payers will recognize such claims.

You Don't Need Face-to-Face Time CPO services are time-based, non-face-to-face E/M services that include many tasks physicians regularly perform for the long-term management of home health agency, hospice or nursing facility patients under their care (see sidebar for a list of CPO codes, definitions and included services).

Take note: Even though face-to-face time is not required for CPO, a physician billing CPO must have had a face-to-face encounter with the patient within at least six months prior to reporting a CPO claim. Qualifying E/M services include 99221-99263 and 99281-99357. Lab, surgical and electrocardiogram services are not sufficient face-to-face encounters to qualify for CPO. Know When You Can Report CPO During Global Suppose Dr. Jones performs surgery on a patient and decides that the patient requires a month of home healthcare during recovery. To determine whether you can report Dr. Jones' services with a CPO code, you have to decide whether the patient requires healthcare because of the surgery.

Section 15513 of the Medicare Carriers Manual (MCM) states that CPO services are only payable if the service was "not routine postoperative care provided in the global surgical period of a surgical procedure billed by the physician."

"If the patient only requires home healthcare because he's recovering from surgery, then the CPO is included in the global surgical package," says Quinten A. Buechner, MS, MDiv, CPC, CHCO, president of ProActive Consultants, a healthcare reimbursement consulting firm in Cumberland, Wis.

For example, if a surgeon performs spinal surgery with instrumentation and requests that a home health practitioner visit the patient weekly to check for infection and help the patient perform range-of-motion exercises, the surgeon cannot report the CPO codes. Don't Include Travel Time or NPP Services You cannot report all physician services as CPO, even [...]