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Family Practice Coding Alert

New HCPCS Codes Render Payment for Home Health Certification

HCFA introduced two temporary (HCPCS) codes in 2001, giving family physicians (FP) an avenue for reporting and being paid for certification of home healthcare patients.

The new codes, which became effective Jan. 1, are:

G0179 MD recertification, HAA patient; and

G0180 physician certification services for Medicare-covered services provided by a participating home health agency (patient not present), including review of initial or subsequent reports of patient status, review of patients responses to the Oasis assessment instrument, contact with the home health agency to ascertain the initial implementation plan of care, and documentation in the patients office record, per certification period.

These codes will be a great help, says Diane Farris, CPC, coding specialist for Southern Chester County Family Practice Associates in Oxford, Pa. In the past, we werent reimbursed for these services. Its good finally to see an official method for reporting them.

G0180 Reported for New Plan of Care

Code G0180 is reported when a family physician initially prescribes Medicare-covered home health agency care, which typically includes nursing, as well as limited housekeeping services to homebound patients. Physician certification encompasses creation and review of a plan of care, and initial verification that the home health agency complies with it. A family physicians review of data collected in the home health agencys patient assessment, which includes the Outcome and Assessment Information Set (OASIS), is encompassed in G0180.

Care must be provided in the patients private residence to individuals unable to transport themselves to the FPs office for visits. Patients do not need to be present when the physician develops the care plan for the home health services.

Creating a Typical Certification Plan

An 80-year-old man with chronic obstructive pulmonary disease is recovering from gall bladder surgery. Because of the potential for complications, the family physician monitoring the patients recovery feels it is appropriate to send a nurse from a home health agency to see the patient two times per week for the first four weeks, and once per week thereafter.

The FP asks the nurse to assess the effect of the medications being given, the patients gastrointestinal status, nutrition, hydration status and the healing of the incision. Physical therapy, bathing and light housekeeping are also ordered from the agency. The physician dictates the orders to the agency via the telephone. In addition, the FP creates goals for the patient and expectations for the patients progress.

Farris explains that G0180 describes initial certification for patients who have not received home health services for 60 days or longer. If a plan were extended beyond 60 days, G0179 would be assigned. According to HCFA guidelines, recertification may apply to the care plan that was previously certified or a modification of [...]