Wiki G0454

[adriennedolezal]

Anyone have experience billing G0454? My practice is going to start using it and I have a few questions. We are a practice that sees patient's in SNF's and do not have an actual office.

1. What place of service would you use with G0454 when patient is in a SNF? I would assume POS 31 (skilled) would be fine but wanted to see if there are any issues anyone has had with this.

2. Can G0454 be billed by the physician on the same day as a D/C (99315/99316) by an NP/PA. Documents for DME are usually signed when the D/C is being completed.

 

[SharonCollachi]

The code is for the physician to sign off on the orders that a PA/NP has had a face-to-face with the patient within the last six months prior to the order of the DME. Since the patient is in the hospital/facility, they don't need a separate face-to-face, because they've already been seen in the facility. So I'm thinking it wouldn't apply, because there is no separate f-t-f to document, and an E&M code has already been billed for that day. After the patient leaves the facility, if they need DME, the physician can use the hospital records if they are within the last six months of the new order and bill G0454.

MLN Matters Article.

Another article.