Wiki G codes and times

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Hi all,

I have a few providers who insist on submitting billable Gcodes for weight counseling, depression discussion, tobacco counseling etc when there is "template" documentation. These template responses are generic in nature and not specific to patient case ie "patient counseled on diet and exercise". Nothing definitive to show that the provider actually spent time discussing these with the patient. For one provider he will only allow AWVs to be scheduled in 15 minute slots. We have timed him and he spends an average of 4 minutes in the room with the patient. He insists that because we have the patient fill out a questionnaire and he reviews the questionnaire, he can safely bill for those codes. Gut check tells me this is wrong and he is trying to boost his revenue and numbers due to a recent comp model change for the providers. We have reviewed the required documentation with him regarding these and other codes however, he insists he is correct. As a side note, we have complaints all the time from his patients when they see their EOB that lists these GCode services. They state comments like "we never talked about those things".
What would be our next steps to ensure compliance?
 
For anything that has the word "counseling" in it, there must actually be... counseling. The word counseling does not mean reviewing a form instead of talking to the patient. And for screening, it is not enough to review a form, it should be reviewed WITH the patient.

For all time-based codes, the time spent must be documented in the record. For instance, G0444, Annual Depression Screening, 15 minutes. Palmetto GBA, for example, says this about G0444:

Documentation should include the following:
  • Depression in older adults may exist with other illnesses including cancer, arthritis, stroke, chronic lung disease and cardiovascular disease. What disease process is present that may be an underlying factor as it relates to depression?
  • What risk factors is the patient exhibiting? Do they feel sad or empty? Less interested in daily activities? Experiencing weight loss or gain when not dieting? Decreased ability to think or concentrate? Always tearful? Experiencing feelings of worthlessness and thoughts of death or suicide?
  • Describe the type of loss if any, they are experiencing (i.e., job status/financial difficulty, death of friends or loved ones, etc.)
  • The Patient Health Questionnaire is the most common screening tool used to identify risk. Be certain to include the tool used and the findings.
  • Plan of care (POC) includes patient education and support for patient self-management. POC also pays attention to patient preferences regarding counseling, medications and referrals to mental health professionals with or without continuing involvement by the patient’s primary care physician.
Remember: Coverage is limited to screening services and does not include treatment options for depression or any diseases, complications or chronic conditions resulting from depression, nor does it address therapeutic interventions such as pharmacotherapy, combination therapy (counseling and medications).

And if you still get pushback, I suggest this little gem: It only takes one really pissed off patient to start trouble. If I saw all these things on an EOB, I would probably be that patient.
 
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