Wiki Home Health Coding...help!!!

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nekedw

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I am a tad-bit confused with the billing. I have a Dr that sees alot of Home Health Patients. When do I use the 60 day date range? What CPT code? G0179 or G0181? I have noticed that I could have been using 99370..does it pay much? Should I go back and bill that code for reimbursement?

Neke Thomas:eek:
 
The 'G' codes are specific to Medicare - one is for the initial cert and the second for the recert.

You should check the LCD for your contractor on the appropriate use. They have specific documentation requirements and certification periods in which the codes can be billed. One of the most common problems we have is our physicians bill the recert too frequently and often, while auditing, the documentation doesn't support the 'full' service of the code. This leds to educating the physicians and quite frankly, since the requirements are so strict, a lot of our docs have decided to not bill it anymore. Not to mention these codes reimburse so little, for the amount of work. They still provide the service of course, but just don't care to deal with the hassle.

I have not been successful in finding a firm code that directly correlates to the G codes that could be used for commercial carriers.

My only suggestions would be to call some of your major carriers, talk to a provider rep and see if they can offer any other options.
 
nekedw said:
I am a tad-bit confused with the billing. I have a Dr that sees alot of Home Health Patients. When do I use the 60 day date range? What CPT code? G0179 or G0181? I have noticed that I could have been using 99370..does it pay much? Should I go back and bill that code for reimbursement?

Neke Thomas:eek:
Click to expand...

Hi,
I got some info from the internet- hope that helps you a little-

By definition, the procedure G0181 is time spent for a revision of a set care plan for home health, it is not meant to establish the care plan for certification or recertification purposes as G0180 and G0179, respectively. Several providers in the billing history had billed G0181 services exclusively-
 
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