Wiki G0180 POS Requirements

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adriennedolezal

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My practice is looking into billing the G0180. We see patients in skilled nursing facilities so POS (31) and do not see patients in the office (as we do not have an actual physical office). I am seeing some issues with possible consolidated billing with G0180 with the SNF but then our providers are the signing the HH POC.

Can anyone tell me if our provider see's the patient within the last 90 days (which is usually within the last 7 days if we can bill the G0180 with POS 31?
 
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What issues are you seeing? G0180 is a physician service code with no site of service differential and not subject to consolidated billing - you should have no problem billing this with POS 31 and the payment will be the same as would be if billed in any other place of service.
 
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We have not billed it yet but researching it as it's something we do daily but never captured it for reimbursement.

This is something I found:
The place of service code should represent the place where the majority of the plan development and review work was performed. These services generally will take place in the physician’s office when they are coordinating aspects of the patient’s care. The CPT description ("Physician certification / recertification for Medicare-covered home health services under a home health plan of care (patient not present).....") does not emphasis the presence of beneficiary during certification or recertification. Hence the Place of service code for Home Health Certification and Care Plan Oversight Services (G0179, G0180, G0181 and G0182) would be 11 (Physician Office). Home Health and CPO services is not covered for a patient in Skilled Nursing Facility and will deny when billed with POS 31 or 32.
 
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It's true that CPO is not covered while the patient is in the SNF, but I've never actually seen it billed with that POS so I don't know if it would actually deny or not. But the CMS guidance I've seen does say that the the PO should reflect the work where most of the development of the care plan was conducted. You might try one and see what happens, and if there's any issue, call your Medicare contractor to explain the situation and see what they say.

However, I'd note that the date of service for G0180 can be billed as the date that the certification was signed, which means that if your provider certifies the HH after discharge, you could avoid the problem that way since the patient would no longer be in the SNF at that point. My suspicion would be that the denial, if there is one, would be caused not by the POS but by the date conflict for a service not being a covered benefit during the period of time that the patient is in the facility.
 
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That's what I was reading as well. Usually for us the patient has to have all of the HH set up prior to D/C. HH can't be set up without the signed order so usually our providers do this prior to D/C so everything can be set up once the patient leaves.
 
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My boss gets her information from other providers and don't fully get all of the billing side of things. So we have differences of what we can and cannot do. She says prior to COVID another practice was billing this with POS 31 no problem. I'm not sure on that. Then I'm seeing additional info is needed/required on the claim form like HH provider #?
 
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G0180 is the initial 485 for home health. Your DOS should coincide with their start date. Your physician should sign it but date it for after the discharge date. You are establishing the date you will follow to be sure subsequent 485s (G0479) will be dated minimum of 61 dates after the last or initial one which ever the case may be. We are a house call practice with no physical office for patients to come to, however the physician sign it at our administrative office so we use POS 11.
 
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