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Home health Cert. Plan review.

  1. #1
    Default Home health Cert. Plan review.
    Medical Coding Books
    Educate me please.
    Say your physician reviewed his patients Home Health Cerfification and Plan of Care form. And instructed on this form that the patient is confined to his/her home and needs intermittent skilled nursing care. Keep in mind the patient is not present. The physician reviewed all the meds, and put the patients DX's on the form, and also came up with a treatment plan.


    Do these codes apply
    CPT 99374-99380

    or

    99339-99440

    Respectfull
    Daniel
    CPC


    P.S- If my question doesn't make sense, just ask I'll try and be more clear.

  2. #2
    Location
    Milwaukee WI
    Posts
    4,466
    Default Is the patient under the care of a Home Health Agency?
    Daniel,

    First ...all the codes you mention are billed ONCE PER MONTH, and can only be billed by the physician who has the predominant supervisory role with the particular patient. It's best if the physician has a spreadsheet on which s/he keeps track of the time involved throughout the calendar month, and then bill at the end of the month, totalling the times to arrive at the correct code (15-29 minutes vs 30 minutes or more)

    Next, ask yourself if the patient under the care of a Home Health Agency, Hospice or Nursing Facility?
    If yes, the 99374-80 might apply IF the patient requires "recurrent supervision of therapy." (Direct quote from CPT). So if this is a one-time paperwork situation, then this would not apply.

    If the answer to the question is NO (no home health agency, etc)... then look at codes 99339-40. Bear in mind that the instructions for these codes are the same as for 99374-80 ... once per month, primary supervisory role, etc. So, again, you'd want a spreadsheet (or some type of log) to keep track of time throughout the month, and you would bill just once per month.

    Hope this helps.

    F Tessa Bartels, CPC, CPC-E/M
    Last edited by FTessaBartels; 08-14-2008 at 03:41 PM.

  3. Default
    Is this a Medicare Patient.....would G0179 apply to your case?

  4. #4
    Default
    We are a family practice and also do home health certifications, most of our patients are medicare and we use the G0179, keep in mind, they have to have been seen in the prior 6 month period in the office.

  5. #5
    Default This is a PPO patient.
    Thank you for all the responses.
    As I mentioned above. This is a PPO patient. Thank you for pointing out the time factor on these codes. Makes a big difference.


    So let's see if I get this right, so if the physician I work for decides to put his patient into a Home Health Agency, Hospice or Nursing Facility. And reviews his labs and documents. And issues a Home health Cert. Plan, and spends
    15-29 minutes vs 30 minutes or more in this process.

    I can bill out CPT 99374-80.

    Respectfully
    Daniel
    CPC

  6. #6
    Post Article on HHPC
    Belinda S. Frisch, CPC, CEMC
    Author of "Correct Coding for Medicare, Compliance, and Reimbursement"

  7. #7
    Location
    Milwaukee WI
    Posts
    4,466
    Default Only If ...
    Quote Originally Posted by daniel View Post
    Thank you for all the responses.
    As I mentioned above. This is a PPO patient. Thank you for pointing out the time factor on these codes. Makes a big difference.


    So let's see if I get this right, so if the physician I work for decides to put his patient into a Home Health Agency, Hospice or Nursing Facility. And reviews his labs and documents. And issues a Home health Cert. Plan, and spends
    15-29 minutes vs 30 minutes or more in this process.

    I can bill out CPT 99374-80.

    Respectfully
    Daniel
    CPC
    Daniel,
    ONLY if ...
    1) the patient requires Recurrent supervision of therapy -and-
    2) the total time spent throughout the month would determine which code you'd use.

    SO, I'd wait till the end of the month, and check the doctor's log for total time spent throughout the month providing the recurrent supervision of therapy before I'd attempt to bill these codes.

    The description / guidelines for these codes in CPT include the following:
    The work involved in providing very low intensity or infrequent supervision services is included in the pre- and post-encounter work for home, office/outpatient and nursing facility or domiciliary visit codes.

    A one-time visit to make the initial decision to have the patient placed into these situations and completing the necessary paperwork does not qualify as "recurrent supervision of therapy."

    Hope this helps.

    F Tessa Bartels, CPC, CPC-E/M
    Last edited by FTessaBartels; 09-19-2008 at 02:54 PM.

  8. #8
    Default
    This information was very useful. It can also be very confusing. So you are telling me that we can charge 99374 each month if pt has continued use of PT?
    Also I am confused on G0179 re-cert, is this where we put the 60-day time frame on the charge or is it 60 units?

    HELP???

  9. #9
    Location
    Milwaukee WI
    Posts
    4,466
    Default Probably Not ...
    nekedW .... probably NOT. Note the word "recurrent" which means multiple episodes of supervising therapy throughout the month. If your physician can document that level of supervision (vs just getting a report from PT and re-signing orders monthly), then you can code the care plan oversight services (99339-40 if at home or assisted living; 99374-78 if patient is in nursing home, hospice or under home health agency.

    I quote from CPT, again: "The work involved in providing... infrequent supervision services is included in the pre- and post-encounter work for home, office/outpatient and nursing facility or domiciliary visit codes. "

    If you're doing this only once a month it does NOT qualify!

    F Tessa Bartels, CPC, CPC-E/M

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