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G0179 or G0180 - OUR Initial Cert, Not Patient's

  1. #1
    Default G0179 or G0180 - OUR Initial Cert, Not Patient's
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    Which code should I use? The patient is new to our practice, hence it is our first/initial certification, but the patient has been certified before so it is a recertification for the patient.

    Thanks in advance for your replies!

    Sue

  2. #2
    Location
    Lynchburg, Virginia
    Posts
    27
    Default Recertification
    I'm going to say recertification. The rules for HH cert. would trump the new patient rule, I think.

  3. #3
    Default
    Thanks, jbrashear. That is what I'm thinking, but there is a contradictory opinion here and I always like to get a second opinion!

  4. Default
    I would bill a recert, also. As I understand it, there are additional guidelines this year. Specifically, the doctor must have had a face to face visit with the patient within 90 days to the certification.

  5. #5
    Location
    Lynchburg, Virginia
    Posts
    27
    Default Recert
    Quote Originally Posted by JanSchell911 View Post
    I would bill a recert, also. As I understand it, there are additional guidelines this year. Specifically, the doctor must have had a face to face visit with the patient within 90 days to the certification.
    That's exactly right. The rules for documentation got a little more strict this year. And if you think about it, we are trying to apply E/M rules to a non E/M service, which I think strengthens the argument for a recert. The only other detail I would even want to point out is that if a patient has gone 90 days+ without having a recert done, then can't you bill an initial certification even if it is for the same dx? I haven't been able to find my info on it for some reason.

    Let me know what you think.

    Janice Brashear, CPC

  6. #6
    Default
    The doc sees the patients at least once every 90 days. Usually more than that.

    As for a new 'initial' cert, good question. Instinctively I'd say lack of a recert doesn't justify a new initial cert, but unfortunately you can't go on instinct today. I'm not sure how they are doing it, but it is certainly something to look into.

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