If you find choosing the right G code for your claims difficult, help is at hand.
Starting Jan. 1, CMS is requiring eight new billing codes in addition to the existing six codes for home health agency services. Those include new nursing codes for RN management and evaluation of the plan of care (G0162), LPN or RN observation and assessment (G0163), and LPN or RN training and education (G0164). CMS is revising G0154 to cover only direct skilled care by an RN or LPN, CMS notes in Dec. 17 Transmittal No. 824 (CR 7182).
“We recognize that, in the course of a visit, a nurse or qualified therapist could likely provide more than one of the nursing or therapy services reflected in the new and revised codes,” CMS says.
But “HHAs must not report more than one G-code for the nursing visit regardless of the variety of nursing services provided during the visit.” The same goes for therapy.
“In cases where more than one nursing or therapy service is provided in a visit, the HHA must report the G-code which reflects the service for which the clinician spent most of his/her time,” CMS instructs. Hopefully this will ease providers’ concerns, voiced at the most recent home health Open Door Forum, about how to choose the right code.
“If direct skilled nursing services are provided, and the nurse also provides training/education of a patient or family member during that same visit, we would expect the HHA to report the G-code which reflects the service for which most of the time was spent during that visit,” CMS says in the transmittal. “Similarly, if a qualified therapist is performing a therapy service and also establishes a maintenance program during the same visit, the HHA should report the G-code which reflects the service for which most of the time was spent during that visit.”
You can check out the transmittal online at www.cms.gov/transmittals/downloads/R824OTN.pdf.