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Care Plan Oversight - I work for a group of orthopedics

R

risnerclan

Networker
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71
Location
Lonoke, AR
Gotta Question...Need Help!

I work for a group of orthopedics and some of our physicians want to charge for care plan oversight. My question is if a patient has a total joint replacement, can our physician charge care plan oversight even though they are in a surgical global period?

Thanks!

Carol
 
If you are talking about G0180, some pay some don't. We bill it also, but not many will pay because of the global. Just have to check with the individual insurance company.
 
I am sorry but this is all new to me. when talking about "care plan oversight" does that pertain to these codes g0181, g0180 and g0179?

do you bill these codes to commerical insurance companies too...

Thanks for your input.

Carol
 
RE: G0179-G0181, look carefully at the definition, (re)certification for Medicare-covered home health services... These codes are for billing Medicare only. We receive Medicare payment for these in the global period. These are additional services provided beyond the "usual" post operative care. For all other payers, see codes 99374-99375.
 
Q: "My question is if a patient has a total joint replacement, can our physician charge care plan oversight even though they are in a surgical global period?"

These services are covered only if all the following requirements are met:

The care plan oversight billed by the physician was not routine post-operative care provided in the global surgical period of a surgical procedure billed by the physician

http://www.cms.hhs.gov/manuals/Downloads/bp102c15.pdf

Section 30-Paragraph G

Also......

http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

Section 180
 
Thank you for those 2 links. Very helpful. I still have some questions, though, and need further help. For one thing, I know that G0181 is considered "care plan oversight", and therefore apparently is not billable during post-op. However, are the home health certification codes G0179 & G0180 considered "care plan oversigt" or not?? I'm trying to determine if they can be billed for certification for home health during a post-op period, such as after a total knee or hip.
Also, I'm having trouble accessing the entire Medicare claims Processing Manual. I've tried www.cms.hhs.gov/manuals & gone to "downloads", but it says no downloads. Under the link you gave for Chapter 12, there's a paragraph that says to also see the Medicare General Information, Eligibility, and Entitlement Manual, Pub. 100-01, Chapter 4, "Physician Certification and Recertification of Services, " (squiggly sign)10-60, and the Medicare Benefit Policy Manual, Pub. 100-02, Chapter 7, "Home Health Services", (squiggly sign) 30. (No, it wouldn't let me copy) Any help on how to access these manuals would be appreciated. Yes, I feel stupid. Thanks!
 
I have the same question as Marge. Can certification and re-certification for home health care be coded during the post-op global? As in Rebecca's arthroplasty example, can the surgeon also report G0180 and/or G0179 during the global period? Or is that considered part of the "normal" post op period? I have a home health agency telling my docs they can do this...I need to find a definitive answer....
 
You pose some tough questions.....I guess it lies within the need of the patient and the contents of the physicians orders......

20.1.2 - Determination of Coverage
(Rev. 1, 10-01-03)
A3-3113.1.B, HHA-203.1.B
The intermediary's decision on whether care is reasonable and necessary is based on information reflected in the home health plan of care, the OASIS as required by 42 CFR 484.55 or a medical record of the individual patient. Medicare does not deny coverage solely on the basis of the reviewer's general inferences about patients with similar diagnoses or on data related to utilization generally, but bases it upon objective clinical evidence regarding the patient's individual need for care.

http://www.cms.hhs.gov/manuals/Downloads/bp102c07.pdf

http://www.cms.hhs.gov/HomeHealthPPS/
 
Thanks, everyone, for the input (I now know how to access the Medicare manuals thru the CMS website for one thing.) After reading much from the Medicare manuals I'm still not clear on the issue of care plan oversight and whether the certification & recertification codes are actually considered "care plan oversight". From what I can tell, it looks like G0181 & G0182 are the codes that are considered "CPO", which would not be paid during global. I think the cert codes G0179 & G0180 would be payable, but again, it's not clear to me.
 
I'm going to assume that the physician is overseeing the care of the home health patient and that the primary care is not involved (if you are uncertain about this, we always require a copy of the OMB form signed by the physician)

CMS established G0180 and G0179 for physicians to use to bill certification and recertification of plans of care for Medicare-covered home health services. The use of these two codes are available only to physicians who are permitted to certify that home health services are required by a patient. G0180 can only be used when patients have not received Medicare covered home health services for at least 60 days. G0179 is used after a patient has received covered home health services for at least 60 days when the physician signs the certification after the initial certification period. G0179 will be reported only once every 60 days, except in the rare situation when the patient starts a new episode before 60 days elapses and requires a new care plan to start a new episode.
 
Lscc

Is any one having trouble with the Medicare replacement plans paying for the G0179. Not sure exactly what the code is for if the certification for the home health services is part of the global. So when can you use this code. Does medicare have a guidline for this code??? if so where can I find it.

Thanks
 
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