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Careplan Oversight & Cert & Recert

  1. Default Careplan Oversight & Cert & Recert
    Medical Coding Books
    The providers I work with are billing for several of these careplan oversights and also the Cert and Recert.

    These three scenarios can be billed simultaneously, correct?

    The Provider would initially do the Cert G0180 and continue with the Careplan Oversight either G0181 or G0182 (depending if its home health or hospice related) and then they could also be doing a Re-cert G0179 every 60 days.

    Or is there an option of just using the Careplan Oversight only? To me it seems they all kind of go together??

    Am I on the right track?

    Thanks in advance again!!


  2. #2
    You can report for the Cert and Re-cert as well as the CPO as long as the requirements are met for both situations.

    Medicare Carriers Manual states that the person who does CPO should be the provider who signed the plan of care. You can find the the specific requirements for each in the MCM manuals:

    Internet Only Manual - Pub. 100-02 Chapter 15 Section Section 30 - G (Care Plan Oversight Info)

    Interent Only Manual - Pub 100-02 Chapter 7 (Certification and Re-certification)

    Documentation for CPO must be very specific - recommend a log to track covered CPO activities along with time spent and bill at the end of each month or billing period. Also remember that to bill CPO the physician must have had a face to face E/M visit billed to Medicare to be covered.

    We just had some denials on this!

    Hope this helps
    Christina Musser, CPC

  3. Red face Cert & Recert
    Thanks CJ!

    I had a note about the GO179 and GO180 for Cert and Re-Cert. It says that it is for Home Health Visits only?? This list of patients I have are for a Hospice Home. So that means I can't bill for these codes correct? They would only be able to have the CPO code G0182 billed.

    I thank you for the weblinks to Medicare and will be reading more!!

    Let me know what you or anyone thinks of the above.


  4. #4

    I believe you are correct in your assessment - if they are Hospice they are under a different benefit than Home Health (even if the Hospice care is taking place at home). The Cert and Re cert codes (G0179 and G0180) apply to the Home Health Benefit and forms 485 and 486. The Hospice certs and re-cert requreiements are different and there is not a separate billing code for that service. The time spent in cert and re-cert for Hospice could be included in the one of the activities of Care Plan Oversight for Hospice (G0182).

    Christina Musser, CPC

  5. Default Care Plan Oversight and Cert & Recert
    Thanks for getting back to me. I think that is right; it will make it easier for me to do this huge list for hospice if it will be just the care plan oversight codes. I really appreciate some input on this topic!

    Have a great Friday!


  6. Default what about private payor?
    One of our doctors just certified a plan of care for a patient who is now receiving home health care. This patient has BCBS. Therefore, I billed this procedure with code 99374 (care plan oversight). BCBS has denied my appeal, and I am not confident that I used the right code. Unfortunately, I cannot find another one. Help!!!!

  7. Default
    99374 PHYSICIAN SUPERVISION OF PT UNDER CARE OF HOME HEALTH AGENCY $73.09 is on the BCBS fee schedule in my state.

    That seems to be the right code. The modifier GV if its the Attending Physician or NP or GW if it is unrelated to the terminal illness.


  8. Default
    thanks! I'll try the GV modifier.

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