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Care Plan Oversight - I work for a group of orthopedics

  1. #1
    Default Care Plan Oversight - I work for a group of orthopedics
    Exam Training Packages
    Gotta Question...Need Help!

    I work for a group of orthopedics and some of our physicians want to charge for care plan oversight. My question is if a patient has a total joint replacement, can our physician charge care plan oversight even though they are in a surgical global period?

    Thanks!

    Carol

  2. #2
    Location
    San Antonio, Tx
    Posts
    73
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    If you are talking about G0180, some pay some don't. We bill it also, but not many will pay because of the global. Just have to check with the individual insurance company.
    Ray Galvez CPC

  3. #3
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    I am sorry but this is all new to me. when talking about "care plan oversight" does that pertain to these codes g0181, g0180 and g0179?

    do you bill these codes to commerical insurance companies too...

    Thanks for your input.

    Carol

  4. #4
    Location
    Capital Coders, Columbia, SC
    Posts
    145
    Default
    RE: G0179-G0181, look carefully at the definition, (re)certification for Medicare-covered home health services... These codes are for billing Medicare only. We receive Medicare payment for these in the global period. These are additional services provided beyond the "usual" post operative care. For all other payers, see codes 99374-99375.

  5. #5
    Location
    North Carolina
    Posts
    3,126
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    Q: "My question is if a patient has a total joint replacement, can our physician charge care plan oversight even though they are in a surgical global period?"

    These services are covered only if all the following requirements are met:

    The care plan oversight billed by the physician was not routine post-operative care provided in the global surgical period of a surgical procedure billed by the physician

    http://www.cms.hhs.gov/manuals/Downloads/bp102c15.pdf

    Section 30-Paragraph G

    Also......

    http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

    Section 180

  6. #6
    Default
    Thank you for those 2 links. Very helpful. I still have some questions, though, and need further help. For one thing, I know that G0181 is considered "care plan oversight", and therefore apparently is not billable during post-op. However, are the home health certification codes G0179 & G0180 considered "care plan oversigt" or not?? I'm trying to determine if they can be billed for certification for home health during a post-op period, such as after a total knee or hip.
    Also, I'm having trouble accessing the entire Medicare claims Processing Manual. I've tried www.cms.hhs.gov/manuals & gone to "downloads", but it says no downloads. Under the link you gave for Chapter 12, there's a paragraph that says to also see the Medicare General Information, Eligibility, and Entitlement Manual, Pub. 100-01, Chapter 4, "Physician Certification and Recertification of Services, " (squiggly sign)10-60, and the Medicare Benefit Policy Manual, Pub. 100-02, Chapter 7, "Home Health Services", (squiggly sign) 30. (No, it wouldn't let me copy) Any help on how to access these manuals would be appreciated. Yes, I feel stupid. Thanks!

  7. #7
    Location
    Greeley, Colorado
    Posts
    2,045
    Question
    I have the same question as Marge. Can certification and re-certification for home health care be coded during the post-op global? As in Rebecca's arthroplasty example, can the surgeon also report G0180 and/or G0179 during the global period? Or is that considered part of the "normal" post op period? I have a home health agency telling my docs they can do this...I need to find a definitive answer....
    Lisa Bledsoe, CPC, CPMA

  8. #8
    Location
    North Carolina
    Posts
    3,126
    Default
    You pose some tough questions.....I guess it lies within the need of the patient and the contents of the physicians orders......

    20.1.2 - Determination of Coverage
    (Rev. 1, 10-01-03)
    A3-3113.1.B, HHA-203.1.B
    The intermediary's decision on whether care is reasonable and necessary is based on information reflected in the home health plan of care, the OASIS as required by 42 CFR 484.55 or a medical record of the individual patient. Medicare does not deny coverage solely on the basis of the reviewer's general inferences about patients with similar diagnoses or on data related to utilization generally, but bases it upon objective clinical evidence regarding the patient's individual need for care.

    http://www.cms.hhs.gov/manuals/Downloads/bp102c07.pdf

    http://www.cms.hhs.gov/HomeHealthPPS/

  9. #9
    Location
    Greeley, Colorado
    Posts
    2,045
    Wink
    Thanks Rebecca. I think I will advise not to code for certification and re-certification in my scenario. It really seems global to me.
    Lisa Bledsoe, CPC, CPMA

  10. #10
    Default
    Thanks, everyone, for the input (I now know how to access the Medicare manuals thru the CMS website for one thing.) After reading much from the Medicare manuals I'm still not clear on the issue of care plan oversight and whether the certification & recertification codes are actually considered "care plan oversight". From what I can tell, it looks like G0181 & G0182 are the codes that are considered "CPO", which would not be paid during global. I think the cert codes G0179 & G0180 would be payable, but again, it's not clear to me.

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