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Home Health Billing - home health code

  1. #1
    Default Home Health Billing - home health code
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    I am wondering if anyone can help me a little. I am very unfamiliar with home health and my google searches aren't pulling up anything useful.

    HCPCS states that G0179 is "...medicare-covered home health services...". Is there a home health code for commercial insurances? We have a claim that was sent to BC/BS and they are denying it.

    I found CPT 99509 "Home visit for assistance with activities of daily living and personal care". Would wound care fall under this if that is what the home health services were requested for (some patients have it for this reason)? This is the first commercial claim I have ever come across billing the home health services but I was wondering how to get this one paid and knowledge for future claims, if there are any.

    Thanks!

  2. #2
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    Have you looked at 99374-99375
    Herbie W Lorona Jr., CPC, CPC-H
    hlorona@up2parmedicalclinic.com

  3. #3
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    have you looked also at S9123-S9124? S9123 cannot be used when 99500-99602 are more appropriate.

  4. Default
    For Home Health billing, skilled nurse visits are billed w/HCPCS code G0154. Wound care is included in this code. This is the code that you need to request on authorization. The 9 series codes are not payable by insurance for Home Health. I do commercial insurance billing for Home Health.

  5. #5
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    Quote Originally Posted by davisa2 View Post
    For Home Health billing, skilled nurse visits are billed w/HCPCS code G0154. Wound care is included in this code. This is the code that you need to request on authorization. The 9 series codes are not payable by insurance for Home Health. I do commercial insurance billing for Home Health.
    Do you bill this per visit or for a date range like billing for home health for Medicare patients (G0179, G0180, etc)?

  6. Default Home Health
    I have a questions I found a code 99348 to bill and I know the POS should be 12 but when I have to add the facility what should I put, the patients address?

  7. Default Home Health billing
    Gina:

    I know this is late, but here goes... Are you billing for skilled nursing visits or shifts? If you are billing for SN visits, you report the nursing revenue code (55X) along with the corresponding HCPCS code on a UB-04. I believe the units of the G code are in 15-minute increments.

    When reporting private duty nursing shifts, you would report S9123 or S9124 on a HCFA-1500 form...each unit equals one hour. That's the way a contracting provider would report their services to the insurance company I work for. To get the Medicare denial for shifts, you would report on a UB-04, revenue code 552 and HCPCS codes S9123 and/or S9124 (each unit = one hour).

    Not sure if this will help anyone, but I hope it does.

  8. Default
    [QUOTE=ctpepenelli;226899]Gina:

    I know this is late, but here goes... Are you billing for skilled nursing visits or shifts? If you are billing for SN visits, you report the nursing revenue code (55X) along with the corresponding HCPCS code on a UB-04. I believe the units of the G code are in 15-minute increments.

    Hello gina i work at a family practice and this home health really confuses me because we bill ours from a home health facility so we have been bill g0179 but it has been getting denied becuase the doctor wants to bill them from the 485 they send us with the date she signs it but medicare states that u can only bill a recertification within the 61st day but hers is not coming up on that its always under and shejust wants to change the dates but you cant do that am i correct?

  9. Default Looking for help with home health audits
    Quote Originally Posted by davisa2 View Post
    For Home Health billing, skilled nurse visits are billed w/HCPCS code G0154. Wound care is included in this code. This is the code that you need to request on authorization. The 9 series codes are not payable by insurance for Home Health. I do commercial insurance billing for Home Health.
    I am the director of the division of medical audit and compliance and need help with home health billing audits. Do you have any interest in doing remote audits? It sounds like you are very familiar with this area and if this is something you would be interested in, please email me at joyceehrlich1@gmail.com. Thanks so much!

  10. Default Any interest in doing remote home health audits?
    [QUOTE=katesanchezoo@yahoo.com;228668]
    Quote Originally Posted by ctpepenelli View Post
    Gina:

    I know this is late, but here goes... Are you billing for skilled nursing visits or shifts? If you are billing for SN visits, you report the nursing revenue code (55X) along with the corresponding HCPCS code on a UB-04. I believe the units of the G code are in 15-minute increments.

    Hello gina i work at a family practice and this home health really confuses me because we bill ours from a home health facility so we have been bill g0179 but it has been getting denied becuase the doctor wants to bill them from the 485 they send us with the date she signs it but medicare states that u can only bill a recertification within the 61st day but hers is not coming up on that its always under and shejust wants to change the dates but you cant do that am i correct?
    I am the director of the division of medical audit and compliance and need help with home health billing audits. Do you have any interest in doing remote audits? It sounds like you are very familiar with this area and if this is something you would be interested in, please email me at joyceehrlich1@gmail.com. Thanks so much!

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