Primary Care Coding Alert

Question: During the final weeks of a patient's life, hospice caregivers call a family physician (FP) regularly about issues such as adjustments to pain medication, the need to start intravenous fluids, and requests for a variety of other prescriptions and orders. The FP logs 90 minutes of phone calls as well as the issues that he discusses and the actions that he recommends during September. Which care plan oversight (CPO) service should I report?

Ohio Subscriber

Answer: To report your FP's services during September, you should use CPT CPO code 99378 (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, review of related laboratory and other studies, communication [including telephone calls] for purposes of assessment or care decisions with health care professional[s], family member[s], surrogate decision maker[s] [e.g., legal guardian] and/or key caregiver[s] involved in patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month; 30 minutes or more) for a private-pay patient and HCPCS level II code G0182 for a Medicare patient.

CPT and Medicare base CPO coding on the patient's location. Codes 99374-99375 (Physician supervision of a patient under care of home health agency [patient not present] in home, domiciliary or equivalent environment [e.g., Alzheimer's facility] ...) and G0181 are for patients under the care of a home health agency. For hospice care patients, as in your example, you should report 99377-99378 or G0182 (... Medicare-approved hospice ...). If the FP provides services to nursing facility patients, you would use 99379-99380 (Physician supervision of a nursing facility patient [patient not present] ...). Medicare, however, doesn't cover CPO for nursing facility patients; Medicare considers this bundled with the payments made for other services provided to nursing facility patients.

Also, Medicare does not separately reimburse CPO services totaling less than 30 minutes. You may report the first 15-29 minutes of care within a calendar month (99374, 99377, 99379) to private payers only. For all insurers, you should report 99375, 99378, 99380 or G0181-G0182 when the FP performs and documents that he provides CPO services totaling 30 minutes or more.