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Family Practice Coding Alert

Two New Coding Options Dispel Confusion When Reporting Care Plan Oversight Services

Understanding and justifying the use of care plan oversight codes (99374-99380) has always been a challenge for family practice coders. This category of evaluation and management (E/M) service became even more complex when CPT 2001 announced preliminary language changes late last year. Care plan oversight codes were revised to reflect more clearly the range of settings in which physician services may be provided and to include involvement by other caregivers such as nonphysician practitioners (e.g., visiting nurses, physical therapists, occupational therapists).

These changes provided a higher degree of specificity, which we havent had in the past, explains Daniel S. Fick, MD, director of risk management and compliance for the College of Medicine faculty practice at the University of Iowa in Iowa City.

However, HCFA did not agree with the revised definitions and implemented new temporary HCPCS codes (G0181 and G0182) to be used with Medicare beneficiaries. As a result, explains Susan Callaway, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C., family practice coders will now have two sets of codes CPT and HCPCS to consider when reporting these services.

CPT Language Broadens Definitions

Fick notes that the six CPT 2001 codes are organized into code pairs:

99374 and 99375 describe care plan oversight with patients under the care of a home health agency delivered in a home, domiciliary or equivalent environment (e.g., Alzheimers facility); 99374 reports 15-29 minutes of services, while 99375 is assigned for 30 or more minutes;

99377 and 99378 reflect the same time breakdown, but describe services provided to hospice patients; and

99379 and 99380 likewise reflect the same time increments, but represent care plan oversight with patients in a nursing facility.

The 2001 revisions include language allowing physicians to count time spent in ... communication (including telephone calls) for purposes of assessment or care decisions with other healthcare professionals and other nonphysician professionals [emphasis added] involved in patients care ... toward the minutes outlined in the code description, Fick adds.

Preliminary Language Revisions Raise Concern

HCFA began implementing the two alternate G codes when CPT initially announced its proposed changes to care plan oversight language in late 2000, Callaway explains. At that time, CPT considered revising the previous code definition to include non-professional caretakers or non-health professionals [emphasis added] in its coverage. HCFA did not agree with these descriptions and determined it did not want to include them in service descriptions used with the Medicare program.

As a result, HCFA implemented G0181 and G0182, which maintain the language found in the CPT 2000 version of the codes:

G0181 physician supervision of a patient receiving Medicare-covered services from a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving [...]