Wiki G0545 Infectious Disease

[kmcintire@widc.biz]

Medicare's new add on code G0545 for infectious disease specialists. I'd love to hear thoughts on what documentation requirements will be needed to justify using this code.

 

[tarachatham]

This code is very similar to G2211. No additional documentation other than what is documented in the MDM for the infectious disease diagnosis of the E&M service. THe Final RUle does give this:

1. Disease Transmission Risk Assessment and Mitigation​

• Developing, following, and supervising specialized, individualized infection control protocols for an individual patient based on their diagnosis and risks in order to reduce risk of disease transmission.
• Coordinating with human resources regarding infection prevention and control measures to enable healthcare facility staff to safely care for patient.
• Counseling patients, family members and caregivers regarding infection prevention.
• Managing infection prevention and treatment protocols associated with transitions of care for complex patients.

2. Public Health Investigation, Analysis, and Testing​

• In-depth patient chart review that entails going back farther in time and assessing the complete breadth of all health care interactions, with higher-level synthesis for complex diagnoses.
• Communicating with the clinical microbiology lab and directly reviewing specimens.
• Coordinating specialized diagnostic evaluations (for example, identifying and facilitating diagnostic laboratory tests only available at specialized laboratories, the state health department, and/or the Centers for Disease Control & Prevention).
• Coordinating with Federal, State and local public health agencies and laboratories to assist with contact tracing, obtaining specimens for specialized testing, and/or identifying prior testing and treatment for communicable diseases in other jurisdictions.

3. Complex Antimicrobial Therapy Counseling & Treatment​

• Counseling patients, family members, and caregivers regarding antimicrobial stewardship and resistance for the patient.
• 
  Engaging in complex medical decision-making associated with antimicrobial prescribing including considerations such as antimicrobial resistance patterns, emergence of new variants/strains, recent antibiotic exposure, interactions/complications from comorbidities including concurrent infections, public health considerations to minimize development of antimicrobial resistance, and emerging and re-emerging infections.

 

[TThivierge]

KMC,
I d probably use that with pts have ongoing infectious ds. problems like dx codes of B20, respiratory ds like J01, pneumonia, Covid U09, or contagious skin infections or Sepsis or ongoing sex disease . I imagine use it the first visit as new patient or when lab results confirm the ds.
I hope helped you
Lady T

 

[hstoner]

Can Physician Assistants bill for this or only medical doctor?

 

[ReneeGillam CPMA CMOM CMC]

When billing 99223 GC, G0545 GC Medicare is denying the 99223 states payment is included in the allowance for another service/procedure. Is anyone else experiencing this or similar issues?

 

[pflanaganpf@aol.com]

can G0525 be billed with consult codes?

 

[jkyles]

can G0525 be billed with consult codes?

Hi there, it cannot. See the full descriptor:

G0545Visit complexity inherent to hospital inpatient or observation care associated with a confirmed or suspected infectious disease by an infectious diseases specialist, including disease transmission risk assessment and mitigation, public health investigation, analysis, and testing, and complex antimicrobial therapy counseling and treatment (add-on code, list separately in addition to hospital inpatient or observation evaluation and management visit, initial, same day discharge, subsequent or discharge)

 

[jkyles]

Can Physician Assistants bill for this or only medical doctor?

Hi there, they can if they have the appropriate training and certification. According to a fact sheet from the IDSA:

If the billing provider is "an infectious disease consultant." This includes infectious disease specialty physicians, but also a mid-level with infectious diseases specialization e.g. a nurse practitioner.

https://www.idsociety.org/globalassets/idsa/clinical-affairs/g0545-fact-sheet.pdf

 

[hmholland]

Is anyone noticing denials for this on commercial payors? Are you finding these are overturned?