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Quality of Life Reimbursement

  1. #1
    Default Quality of Life Reimbursement
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    So my doctor was given this article 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. Default
    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
    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 !!

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