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G0182 and 99347-99350

Suhel Posted Wed 22nd of February, 2012 16:49:43 PM

One of our Medicare patients just got enrolled in Hospice. My doctor will be making house calls for the patient as the patient cannot come to the office anymore. Do i bill 99347-99350 for the house call and G0182 for the care co-ordination? Are there any more codes I can bill? Does modifier -GV need to be used? All help is very much appreciated.

Ldy Answered Wed 22nd of February, 2012 18:31:03 PM

SuperCoder Answered Wed 22nd of February, 2012 18:48:22 PM

Your all codes are correct. For home visits, you should use (99347-99350), CPO for hospice patient, use G0182 with modifier GV (Attending physician not employed or paid under arrangement by the patient's hospice provider). This modifier is necessary to be used with HCPCS code and it explains when a physician is providing a service that is related to the diagnosis for which a patient has been enrolled into hospice. This physician is not associated with the hospice and is providing services as a private physician. There are no other codes required.
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You will get information on CMS Pub 100-4, Chap 11 Section 40.2 about CPO HCPCS modifier
link: http://www.cms.gov/manuals/downloads/clm104c11.pdf

Suhel Posted Wed 22nd of February, 2012 18:53:19 PM

Thanks for your quick response, Linda. Just to clarify further, -GV is used only with G0182, right?
And secondly, is there a limit to how many home visits are allowed? For example, if my doctor sees this patient on a daily basis for the next few days (because the patient is really sick), will Medicare reimburse?
Thanks in Advance.

Suhel Posted Wed 22nd of February, 2012 19:09:12 PM

Thanks for your response too, Birendra. If you guys could just answer the above question, I would appreciate it.
Thanks

Ldy Answered Wed 22nd of February, 2012 19:32:33 PM

All claims for this pt need to have a GV modifer if going to medicare.

SuperCoder Answered Wed 22nd of February, 2012 19:33:46 PM

Yes, GV is only used with G0182. Regarding home visits, there are no limits and it is time based also.Medicare does limit payment for home services to only those patients whose medical condition necessitates treatment at home instead of the physicians office.
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Extra Info: CPT 99347-99350 is to report home visits to established patients. There are only four codes for established home visits, as opposed to the five used for reporting established patient office visits. The established visit codes for home visits match up exactly to the requirements for billing established office visits with the exception of 99211. There is no home-based equivalent for 99211 because that service does not require physician involvement.

The work that you would perform under code 99212 in the office would require you to bill under 99347 for a home-based patient. Similarly, a 99215 office visit code is equivalent to a 99350 code for a home visit. Although the documentation standards are identical, the typical times are longer for home visits. This could affect your coding level decision if you are providing counseling or coordination of care and choose to bill based on time.
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You will be getting still more information on this link:
http://www.aahpm.org/uploads/Billing_Manual_09.pdf (search with Visit location, home or office visits, page 15)

Ldy Answered Wed 22nd of February, 2012 20:17:19 PM

Let us know if u get those home visits paid without the GV modifer on them, cause I say u do need to use the GV on them too....
thx's

SuperCoder Answered Thu 23rd of February, 2012 03:44:46 AM

As per medicare policy, you should must append GV modifier for enrolled hospice patient.

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