Don't have a TCI SuperCoder account yet? Become a Member >>

Otolaryngology Coding Alert


CMS Limits CPO to Plan's Chief

Question: Is there any way to get Medicare to pay for care plan oversight visits?

North Carolina Subscriber

Answer: First, make sure you-re using HCPCS Level II care plan oversight (CPO) codes, not CPT codes (99374-99380). Medicare pays for CPO using G0181 (Physician supervision of a patient receiving Medicare-covered services provided by a participating home health agency [patient not present] requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of laboratory and other studies, communication [including telephone calls] with other healthcare professionals involved in the patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month, 30 minutes or more) and G0182 (describes the same service for a patient in a Medicare-approved hospice).

Major problem: Medicare may be denying your otolaryngologist's CPO because she didn't fulfill this requirement: The physician who bills for the CPO must be the same physician who signed the certification and created the plan of care for the home health agency or hospice in the first place. Your otolaryngologist probably did not admit the patient into the facility and create the initial care plan.

Best bet: The otolaryngologist should consider seeing the patient and using a nursing facility code (99307-99310, Subsequent nursing facility care, per day, for the evaluation and management of a patient ...) or inpatient consultation (such as 99251-99255, Inpatient consultation for a new or established patient -). Both of these services require the physician to provide face-to-face contact with the patient.