Wiki ICD 10 Code for CPT G2012

[cwestman]

Recently the office has decided to use CPT G2012 for care management calls checking pt status creating a plan for care .Call is initiated by the office RN.
Visits are with established pt
Communication does not relate to an E/M provided within 7 days prior or require post follow up(other than regularly scheduled f/u appointments)
They are typically done as check in/ensure no barriers to care
My dilemma is knowing how best to code .
Is it appropriate to use diagnosis conditions pulled in by the RN (that are existing and actively treated by PCP)which I'm reluctant to do.
Or is there a more appropriate ICD 10 code I researched
Encounters (for)without any luck
Management (of) again nothing
Wondering if counseling would be appropriate perhaps Z71.9 0r Z71.89 ?
Z76.89 Persons encountering health services in other specified circumstances
the purpose is for the caller to check pt status review barriers to care and the end product is development of a care plan that promotes patient well being
Appreciate assistance
Cheri

 

[pscanlan]

Is there a particular reason you're using a HCPCS code when there is a CPT equivalent? 99441 seems to have almost exactly the same description as G2012. I haven't had much experience billing either code, but I tend to prefer CPTs over HCPCs as I have found more payers reimburse on CPTs. Strictly anecdotal, no evidence for that trend. Perhaps CMS will pay one and not the other. After a cursory internet search, I have found conflicting reports on what sort of providers are eligible to bill these codes, but in general both appear to be strictly "physician or other qualified healthcare professional." For instance, this website details a statement from CMS regarding care teams billing G2012:

"CMS states its recognition of the important role that others on the care team, such as nurses and other clinical staff, but suggests that any non-face-to-face time spent coordinating care is more appropriately billed under other care management codes (for example, such time may be more appropriate under Chronic Care Management (CCM))."​

Take that with a grain of salt, but it seems like an authoritative website.

Regarding diagnosis, I would code any preexisting condition that the provider documented. Diabetes, hypertension, morbid obesity - the types of systemic diseases that are typically treated by a PCP, but would affect treatments by other physicians. Anything that could be, as you put it, a barrier to care, should be noted.

 

[cwestman]

Thank you

The idea was crafted and implemented by the office manager to use for Care Management calls.
I had researched both HCPCS I and II and honestly thought the same thing as you stated.
The office manager tends to "enforce " plans with a blanket statement that other offices managers are doing this and being reimbursed so we will do as they do.
I'm currently sitting on several encounters pondering a way to proceed
Appreciate very much your thoughts and direction
Cheri

 

[Cynthia Hughes]

This is very problematic. I recommend pulling up the language used by CMS in proposing and adopting this code in the 2019 proposed and final rules for the Medicare Physician Fee Schedule. Here is a key excerpt from the proposed rule (unchanged in the final rule but less clearly stated).
"We expect that these services would be initiated by the patient, especially since many beneficiaries would be financially liable for sharing in the cost of these services. For the same reason, we believe it is
important for patients to consent to receiving these services, and we are specifically seeking comment on whether we should require, for example, verbal consent that would be noted in the medical record for each service. ...We are not proposing to apply a frequency limit on the use of this code by the same practitioner with the same patient, but we want to ensure that this code is appropriately utilized for circumstances when a patient needs a brief non-face-to-face check-in to assess whether an office visit is necessary."

In other words, G2012 would be reported when a patient initiates a call to discuss whether an appointment is needed for a problem (eg, dizziness after starting new medication). The services you describe where nurses are making care management calls would fall under chronic care management (CCM) services assuming all requirements for CCM codes are met.

Good luck with this,
Cindy

 

[jkyles]

In addition to what Cynthia says, the service has to be performed by a physician or a qualified health care professional who is able to bill for E/M services.