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Thread: G0180 G0181 Pls HELP!!!!

  1. #1
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    Default G0180 G0181 Pls HELP!!!!

    We want to know the difference between "certification" G0180 and "supervision" G0181. MCR is not paying G0181 as not medically necessary. This is a confusing code. Any help would be appreciated..
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  2. #2
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    ARE YOU TRYING TO BILL THESE OUT AT THE SAME TIME.

    THAT MAY BE WHY YOUR GETTING THE G0181 KICK BACK.
    JUST A THOUGHT.

    ON ANOTHER NOTE, NEW TO THESE CODES MYSELF. BUT MY INTERPRETATION OF THESE TWO CODES IS

    G0180 IS JUST FOR THE CERTIFICATION OF THE MEDICARE-COVERED HOME HEALTH SERVICES.

    Physicians may bill for the initial certification of Medicare-covered home health services. The physician billing for physician certification must be the provider supervising the patient's care. Services under this category include:

    Review of initial or subsequent reports of patient status

    Review of the patient's responses to the Oasis assessment instrument

    Contact with the home health agency to ascertain the initial implementation of the plan of care

    Documentation in the patient's record

    AS FOR G0181- THAT'S FOR THE ACTUAL CARE PLAN OVER SIGHT OF THE PATIENT. THIS IS BILLED ONCE A MONTH AND REQUIRE A MINIMUM OF 30 MINUTES TOTAL TIME.


    MAYBE ANOTHER PHYSICIAN BILLED THIS OUT (G0181) BEFORE YOUR DOCTORE DID, IF THAT PATIENT IS DEALING WITH ANOTHER PHYSICIAN.


    JUST THROUGHING THIS OUT THERE, LIKE I SAID I'M NEW TO THESE CODES MYSELF.

    RESPECTFULLY
    DANIEL, CPC

  3. #3
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    No, We are not billing them out together. The MD was denied G0181 stating not medically necessary.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  4. #4

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    Maybe your Dx is the problem?

  5. #5
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    Smile

    Quote Originally Posted by kbarron View Post
    We want to know the difference between "certification" G0180 and "supervision" G0181. MCR is not paying G0181 as not medically necessary. This is a confusing code. Any help would be appreciated..
    Karen,
    G0181 is Care Plan Oversight, which is completely different from Certifiications & Recertifications (G0180 & G0179).

    G0181 requires complex or multidisciplinary care modalites involving:
    * Regular physician development and/or revision of care plans;
    * Review of subsequent reports of patient status;
    * Review of related laboratory & other studies;
    * Communication with other health professionals not employed in the same practice who are involved in the patient's care;
    * Integration of new information into the medical treatment plan; and/or
    * adjustment of medical therapy.

    Care Plan Oversight Requirements:
    * The provider who bills CPO must be the same provider who signed the plan of care.
    * The provider may not have a financial or contractual relationship with the HHA.
    * CPO may not be billed "incident-to"
    * Providers billing for CPO must submit claim with no other services billed on that claim and may bill only AFTER the end of the month in which the CPO services were rendered.
    * CPO services may not be billed across calendar months and should be submitted and paid only for one unit of service.

    I hope this helps?
    Evangelina Frohna, CPC, CEMC

  6. #6
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    Thank you Evangelina. It is very helpful. The particular MD is the hospice director and this is also part of the HHA.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  7. Question G0181 billed with G0179

    Evangelina,

    Our Physician routinely provider care plan oversight to HH patients. At the end of the month we will bill out G0181 for the CPO. In a month when a recertification is due we bill out the G0179 in addition to the G0181. The
    G0181 gets denied as a duplicate service. They are billed out on separate claims, as follows.

    Claim #1 09/30/2014--G0179 1 unit
    Claim #2 09/30/2014--G0181 1 unit

    From what I understand they are both payable in the same month.

    Is the G0181 denying because the G0179 was not billed with the date span of the days the CPO was performed (09/15/2014-09/20/2014)? Dates of service entered on the claim form must be the first and the last date during which documented CPO services were rendered and not the first and last date of the month.

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