AAPC - Back to school
Results 1 to 3 of 3

Thread: Quality of Life Reimbursement

  1. #1
    Join Date
    Apr 2007

    Default Quality of Life Reimbursement

    AAPC: Back to School
    So my doctor was given this article http://www.dhs.wisconsin.gov/health/...CCPlan2005.pdf now he wants to know how we can increase reimbursement for services related to quality of life at time of diagnosis and throughout the cancer continuum ? The only thing i can find on this subject was a project CMS developed in Nov 2004 for reporting several G codes and it only lasted through 2005. Can someone please help us on the matter


  2. #2


    Since there is no longer a "project" for this through CMS, we need to look at where quality of life services fall into E/M documentation guidelines. My recommendation would be to begin looking at medical decision making with the provider's documentation. Review the physician (NPP) documentation to find exactly what quality of life services are being performed; e.g., is there a DNR signed, or a decision to de-escalate care? If so, this falls under the "Risk of Morbidity/Mortality" in MDM. Or, is there documentation of counseling and coordination of care? Then, there MUST be time documented, such as "spent 15 min of 25 min appt counseling/coordination of care", as well as a synopsis of what was discussed, and THEN the E/M may be selected based upon time.

    In addition, Care Plan Oversight services could be eligible if there is documentation to support such services.

    Also, there are PQRI codes that should be looked into, if your office is not already using them. In Michigan, our BCBSM also has a similar plan to Medicare for PQRI. PQRI, and other quality of care projects, are an excellent way to earn extra reimbursement.

    There are no CPT or HCPCS codes for quality of life services. It will be up to the provider to determine what they are actually doing for the patient and what category that work falls into.

  3. #3
    Join Date
    Apr 2007


    Thank you, i think he is confused with the Medicare project for 2005 using G codes. Just wanted to see if anyone heard of these codes coming back. Thanks again !!

Similar Threads

  1. A-Life
    By YesicaRuedas in forum General Discussion
    Replies: 0
    Last Post: 02-11-2013, 09:05 AM
  2. End of life
    By flngub in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 10-11-2011, 09:23 AM
  3. Life port
    By nyyankees in forum Anesthesia
    Replies: 2
    Last Post: 05-08-2009, 09:27 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.