Forum - Questions & Answers

Dec 10th, 2012 - Trina71 3 

HCPCS g0181

Can someone assist with coding for "oversight care", do I have to add E/M code or does G0181 stand alone.

Thanks in advance

Dec 10th, 2012 - nmaguire   2,606 

re: HCPCS G0181

If your situation meets all the requirements listed below, you are eligible to bill for your services:

--The physician cannot have a significant financial arrangement with the home health agency or hospice that is providing care to the patient.
--The physician may not be an employee or medical director of the home health agency or hospice.
--Only one physician per month may bill CPO.
--Neither a physician who is billing for the end-stage renal disease services under a capitation arrangement nor a physician who is providing surgical follow-up in the global period may bill for CPO.
--The physician who bills for the CPO must be the same physician who signed the certification for the home health agency or hospice in the first place.
--The physician must have had a face-to-face service with the patient within six months of billing for the CPO. (CPO)This is a non-face-face service.)
--The physician must have personally provided at least 30 minutes of service in one calendar month.
--The beneficiary must be receiving Medicare covered home health or hospice services during the period in which CPO is billed.
--The beneficiary must require complex or multidisciplinary care modalities requiring ongoing physician involvement in the patient's plan of care.
The definition of G0181 is “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 health care 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.”

Dec 10th, 2012 - Trina71 3 

re: HCPCS G0181

Thank you- the second part of my question is can I just submit the G code alone or do I need any addt'l CPT® code with it?

Dec 10th, 2012 - nmaguire   2,606 

re: HCPCS G0181

If all criteria is met, should be good to go with G code alone



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