Guest guest Posted January 15, 2006 Report Share Posted January 15, 2006 The most helpful coding tool I have is my EMR, (Healthmatics from A4) which incorporates the ICD-9, CPT and HCPCs databases, as well as SMOMEDs which is handy if you can’t find the diagnosis you are looking for in ICD9 (and is entertaining because it includes lots of really weird veterinary stuff). It also has an E & M calculator that I use to be sure I have met criteria for whatever level I want to code for a particular visit. What I know about the Welcome to Medicare thing I mostly got from FPM, Medical Economics and Physicians Practice magazines. Use of the -25 modifier gets discussed on this list and on Practicemgt, so I have taken what I read there and just tried it. I have been pleasantly surprised most of the time. The LEAST helpful resource is my billing service which persists in telling me “they won’t pay” when I want to try things like prevention plus E & M-25 or 99050. I just don’t listen anymore and try it anyway. I do have to give them credit for sharing how another office bills for home health supervision, but only after I asked about it. I hate to think of all the times I have reviewed and signed care plans for free, but I don’t do that anymore. I have not taken any coding courses, and when I see how much they cost, I don’t think I ever will. Annie RE: BILLING - SURG PROCEDURE and MED >> OFFICE VISIT SAME DAY?? >>Date: Thu, 12 Jan 2006 08:36:03 -0500 >> >>You must have better companies there. I tried that several times & it > was >>never paid. I'm starting to think I need to pick a better state than > Ohio, >>based on others practice stories here. >> >> >> >> >> >> >> > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 15, 2006 Report Share Posted January 15, 2006 Nice review of what works for you... now, about that home health supervision, how do you code for it? I've got a ton of Medicare (group home patients, elderly and many of my deaf patients too) and my current organization doesn't submit diddly for that. I plan to do better in so many ways -- coding for that would be great. Any more help you can offer will be appreciated. BTW, I believe I picked up a good deal from discussions on this list but I also think I've been helped by the two day course before the AAFP Assembly called " Cash, Codes and Computers " . But I admit, it was helpful for me as I needed to learn so much -- many of you already have a great foundation of knowledge and the course may have been a waste of time. Tim > The most helpful coding tool I have is my EMR, (Healthmatics from A4) > which incorporates the ICD-9, CPT and HCPCs databases, as well as > SMOMEDs which is handy if you can't find the diagnosis you are looking > for in ICD9 (and is entertaining because it includes lots of really > weird veterinary stuff). It also has an E & M calculator that I use to be > sure I have met criteria for whatever level I want to code for a > particular visit. What I know about the Welcome to Medicare thing I > mostly got from FPM, Medical Economics and Physicians Practice > magazines. Use of the -25 modifier gets discussed on this list and on > Practicemgt, so I have taken what I read there and just tried it. I > have been pleasantly surprised most of the time. The LEAST helpful > resource is my billing service which persists in telling me " they won't > pay " when I want to try things like prevention plus E & M-25 or 99050. I > just don't listen anymore and try it anyway. I do have to give them > credit for sharing how another office bills for home health supervision, > but only after I asked about it. I hate to think of all the times I > have reviewed and signed care plans for free, but I don't do that > anymore. I have not taken any coding courses, and when I see how much > they cost, I don't think I ever will. > Annie > > > RE: BILLING - SURG PROCEDURE and MED >>> OFFICE VISIT SAME DAY?? >>>Date: Thu, 12 Jan 2006 08:36:03 -0500 >>> >>>You must have better companies there. I tried that several times & it >> was >>>never paid. I'm starting to think I need to pick a better state than >> Ohio, >>>based on others practice stories here. >>> >>> >>> >>> >>> >>> >>> >> >> >> >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 15, 2006 Report Share Posted January 15, 2006 OK-I went out and did my homework, which as usual, involves searching in the AAFP Family Practice Management journal, usually my best hope for coding info. Here are two responses to Tim's question (and my own question) about coding for care oversight on patients. I think this is what Tim's referring to. These are both from the invaluable and nerdy coding column in the FPM magazine, something I hardly read until I found Gordon's articles in them and changed my life.Medicare certification and recertificationQ I recently learned that I can be reimbursed for certification (G0180) and recertification (G0179) of Medicare-covered home health in addition to care plan oversight (G0181). Are there similar reimbursable codes for initial certification or recertification of Medicare-covered skilled nursing and long-term care nursing?A No. Medicare has not established any similar codes for nursing-facility patients.Care plan oversight for Medicare patientsQ I supervised the terminal care provided to a Medicare patient by home-health nurses and submitted 99375, "Physician supervision of a patient under care of home health agency ...; 30 minutes or more," for my time, but Medicare denied the service. Should I have used a different code?A CPT code 99375 does accurately describe the care you provided, but Medicare does not recognize this code. Instead, you should submit G0181, "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," when you provide this service to Medicare patients (or G0182 if the patient is under a Medicare-approved hospice). Nice review of what works for you... now, about that home health supervision, how do you code for it? I've got a ton of Medicare (group home patients, elderly and many of my deaf patients too) and my current organization doesn't submit diddly for that. I plan to do better in so many ways -- coding for that would be great. Any more help you can offer will be appreciated. BTW, I believe I picked up a good deal from discussions on this list but I also think I've been helped by the two day course before the AAFP Assembly called "Cash, Codes and Computers". But I admit, it was helpful for me as I needed to learn so much -- many of you already have a great foundation of knowledge and the course may have been a waste of time. Tim > The most helpful coding tool I have is my EMR, (Healthmatics from A4) > which incorporates the ICD-9, CPT and HCPCs databases, as well as > SMOMEDs which is handy if you can't find the diagnosis you are looking > for in ICD9 (and is entertaining because it includes lots of really > weird veterinary stuff). It also has an E & M calculator that I use to be > sure I have met criteria for whatever level I want to code for a > particular visit. What I know about the Welcome to Medicare thing I > mostly got from FPM, Medical Economics and Physicians Practice > magazines. Use of the -25 modifier gets discussed on this list and on > Practicemgt, so I have taken what I read there and just tried it. I > have been pleasantly surprised most of the time. The LEAST helpful > resource is my billing service which persists in telling me "they won't > pay" when I want to try things like prevention plus E & M-25 or 99050. I > just don't listen anymore and try it anyway. I do have to give them > credit for sharing how another office bills for home health supervision, > but only after I asked about it. I hate to think of all the times I > have reviewed and signed care plans for free, but I don't do that > anymore. I have not taken any coding courses, and when I see how much > they cost, I don't think I ever will. > Annie > > > RE: BILLING - SURG PROCEDURE and MED >>> OFFICE VISIT SAME DAY?? >>>Date: Thu, 12 Jan 2006 08:36:03 -0500 >>> >>>You must have better companies there. I tried that several times & it >> was >>>never paid. I'm starting to think I need to pick a better state than >> Ohio, >>>based on others practice stories here. >>> >>> >>> >>> >>> >>> >>> >> >> >> >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 16, 2006 Report Share Posted January 16, 2006 -- Your good, real good. Thanks for finding that. And for reminding me to be more consistent with my FPM reading ... something I hope will be possible in about two months. .... and speaking of March... personal update here -- signed my lease for a 462sqft space in a small community mall (front of my space looks like a shop not a standard mall front) that'll have a small waiting room, large main room for desk/patient chairs (two recliners)/exam table area with sink behind curtain, and a storage room. Bathrooms in the mall are next to me (so I'm not paying rent for a toilet... I love that!). Cost is about $520 month with a low cost for electricity beyond that. I'm happy! I'll pass along photos as it transitions. Thanks again to all you in the vanguard of this movement. Tim > OK- > > I went out and did my homework, which as usual, involves searching in > the AAFP Family Practice Management journal, usually my best hope for > coding info. Here are two responses to Tim's question (and my own > question) about coding for care oversight on patients. > > I think this is what Tim's referring to. These are both from the > invaluable and nerdy coding column in the FPM magazine, something I > hardly read until I found Gordon's articles in them and changed my life. > > Medicare certification and recertification > > Q I recently learned that I can be reimbursed for certification > (G0180) and recertification (G0179) of Medicare-covered home health in > addition to care plan oversight (G0181). Are there similar > reimbursable codes for initial certification or recertification of > Medicare-covered skilled nursing and long-term care nursing? > > A No. Medicare has not established any similar codes for nursing- > facility patients. > > Care plan oversight for Medicare patients > Q I supervised the terminal care provided to a Medicare patient by > home-health nurses and submitted 99375, " Physician supervision of a > patient under care of home health agency ...; 30 minutes or more, " for > my time, but Medicare denied the service. Should I have used a > different code? > > A CPT code 99375 does accurately describe the care you provided, but > Medicare does not recognize this code. Instead, you should submit > G0181, " 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, " when you provide this service to Medicare patients > (or G0182 if the patient is under a Medicare-approved hospice). > > > > > > > > > > >> Nice review of what works for you... now, about that home health >> supervision, how do you code for it? >> I've got a ton of Medicare (group home patients, elderly and many of >> my >> deaf patients too) and my current organization doesn't submit >> diddly for >> that. I plan to do better in so many ways -- coding for that would be >> great. Any more help you can offer will be appreciated. >> >> BTW, I believe I picked up a good deal from discussions on this list >> but I >> also think I've been helped by the two day course before the AAFP >> Assembly >> called " Cash, Codes and Computers " . But I admit, it was helpful for >> me as >> I needed to learn so much -- many of you already have a great >> foundation >> of knowledge and the course may have been a waste of time. >> >> Tim >> >> > The most helpful coding tool I have is my EMR, (Healthmatics from >> A4) >> > which incorporates the ICD-9, CPT and HCPCs databases, as well as >> SMOMEDs which is handy if you can't find the diagnosis you are >> looking >> > for in ICD9 (and is entertaining because it includes lots of really >> weird veterinary stuff). It also has an E & M calculator that I >> use to be >> > sure I have met criteria for whatever level I want to code for a >> particular visit. What I know about the Welcome to Medicare thing I >> mostly got from FPM, Medical Economics and Physicians Practice >> magazines. Use of the -25 modifier gets discussed on this list >> and on >> > Practicemgt, so I have taken what I read there and just tried it. I >> have been pleasantly surprised most of the time. The LEAST helpful >> resource is my billing service which persists in telling me " they >> won't >> > pay " when I want to try things like prevention plus E & M-25 or >> 99050. I >> > just don't listen anymore and try it anyway. I do have to give them >> credit for sharing how another office bills for home health >> supervision, >> > but only after I asked about it. I hate to think of all the times I >> have reviewed and signed care plans for free, but I don't do that >> anymore. I have not taken any coding courses, and when I see how >> much >> > they cost, I don't think I ever will. >> > Annie >> > >> > >> > RE: BILLING - SURG PROCEDURE and >> MED >> >>> OFFICE VISIT SAME DAY?? >> >>>Date: Thu, 12 Jan 2006 08:36:03 -0500 >> >>> >> >>>You must have better companies there. I tried that several >> times & it >> >> was >> >>>never paid. I'm starting to think I need to pick a better state >> than >> >> Ohio, >> >>>based on others practice stories here. >> >>> >> >>> >> >>> >> >>> >> >>> >> >>> >> >>> >> >> >> >> >> >> >> >> >> >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 16, 2006 Report Share Posted January 16, 2006 It sounds like you are only coding & billing for HH initial certification & recertification. You should also be coding & billing for care plan oversight (CPO). That is how you bill for all of those additional forms, UA orders, etc. that you mentioned. You just get a copy of a form to keep track each calendar month of these things (usually in 5 minute increments) & then code & bill at the end of the month if the total CPO minutes was > 30. I get my form from the American Academy of Home Care Physicians (AAHCP). The HH code is G0181 & for hospice is G0182. I’m surprised you know about the cert/recert thing but not the monthly CPO. Most doctors actually have it the other way around and are not aware you can code those cert/recerts in addition to the monthly CPO. RE: BILLING - SURG PROCEDURE and MED >>> OFFICE VISIT SAME DAY?? >>>Date: Thu, 12 Jan 2006 08:36:03 -0500 >>> >>>You must have better companies there. I tried that several times & it >> was >>>never paid. I'm starting to think I need to pick a better state than >> Ohio, >>>based on others practice stories here. >>> >>> >>> >>> >>> >>> >>> >> >> >> >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 17, 2006 Report Share Posted January 17, 2006 How do you keep track of it all. And what code do you use for CPO. Can it roll over month to month. Example would nursing home calls and orders fall under CPO. Brock DO wrote: It sounds like you are only coding & billing for HH initial certification & recertification. You should also be coding & billing for care plan oversight (CPO). That is how you bill for all of those additional forms, UA orders, etc. that you mentioned. You just get a copy of a form to keep track each calendar month of these things (usually in 5 minute increments) & then code & bill at the end of the month if the total CPO minutes was > 30. I get my form from the American Academy of Home Care Physicians (AAHCP). The HH code is G0181 & for hospice is G0182. I’m surprised you know about the cert/recert thing but not the monthly CPO. Most doctors actually have it the other way around and are not aware you can code those cert/recerts in addition to the monthly CPO. RE: BILLING - SURG PROCEDURE and MED>>> OFFICE VISIT SAME DAY??>>>Date: Thu, 12 Jan 2006 08:36:03 -0500>>>>>>You must have better companies there. I tried that several times & it>> was>>>never paid. I'm starting to think I need to pick a better state than>> Ohio,>>>based on others practice stories here.>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 17, 2006 Report Share Posted January 17, 2006 Thanks! The fact that I have not had any organized instruction in how to do this probably explains the holes in my knowledge. And in MY experience doctors don’t bill for ANY of this, they just give it away for free. Only by participating in this list and the AAFP practicemgt list have I learned what little I know. Annie RE: BILLING - SURG PROCEDURE and MED >>> OFFICE VISIT SAME DAY?? >>>Date: Thu, 12 Jan 2006 08:36:03 -0500 >>> >>>You must have better companies there. I tried that several times & it >> was >>>never paid. I'm starting to think I need to pick a better state than >> Ohio, >>>based on others practice stories here. >>> >>> >>> >>> >>> >>> >>> >> >> >> >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 17, 2006 Report Share Posted January 17, 2006 http://www.infingo.com/index.php?session=0 & action=cpo Here is a palm program that I use to track minutes to bill CPO. J.Weber, MD Housecall Family Practice J Weber, PC PO Box 820044 Memphis, TN 38182 doctor@... CONFIDENTIALITY NOTICE > The information contained in this e-mail message, including any files attached to it, may contain confidential or other privileged material and is intended only for the use of the individual identified above and others who have been specifically authorized to receive such information. Review, dissemination, or distribution of this e-mail, other than by the intended recipient, is strictly prohibited. The information herein may also be protected by the Electronic Communications Privacy Act, 18 USC Sections 2510-2521. If you have received this e-mail message in error, please notify the sender immediately by replying to this e-mail or by calling (901)2786963 and delete this e-mail from your system. > From: [mailto: ] On Behalf Of Annie Skaggs Sent: Monday, January 16, 2006 7:01 PM To: Subject: RE: BILLING Skills Thanks! The fact that I have not had any organized instruction in how to do this probably explains the holes in my knowledge. And in MY experience doctors don’t bill for ANY of this, they just give it away for free. Only by participating in this list and the AAFP practicemgt list have I learned what little I know. Annie RE: BILLING - SURG PROCEDURE and MED >>> OFFICE VISIT SAME DAY?? >>>Date: Thu, 12 Jan 2006 08:36:03 -0500 >>> >>>You must have better companies there. I tried that several times & it >> was >>>never paid. I'm starting to think I need to pick a better state than >> Ohio, >>>based on others practice stories here. >>> >>> >>> >>> >>> >>> >>> >> >> >> >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 17, 2006 Report Share Posted January 17, 2006 How do you realy keep track of the time you spend reviewing all the forms that come into the practice and record to keep track of time. What is your process like. Brent > > It sounds like you are only coding & billing for HH initial certification & > recertification. You should also be coding & billing for care plan > oversight (CPO). That is how you bill for all of those additional forms, UA > orders, etc. that you mentioned. You just get a copy of a form to keep > track each calendar month of these things (usually in 5 minute increments) & > then code & bill at the end of the month if the total CPO minutes was > 30. > I get my form from the American Academy of Home Care Physicians (AAHCP). > The HH code is G0181 & for hospice is G0182. I'm surprised you know about > the cert/recert thing but not the monthly CPO. Most doctors actually have > it the other way around and are not aware you can code those cert/recerts in > addition to the monthly CPO. > > > > > > > > RE: BILLING - SURG PROCEDURE and MED > >>> OFFICE VISIT SAME DAY?? > >>>Date: Thu, 12 Jan 2006 08:36:03 -0500 > >>> > >>>You must have better companies there. I tried that several times & it > >> was > >>>never paid. I'm starting to think I need to pick a better state than > >> Ohio, > >>>based on others practice stories here. > >>> > >>> > >>> > >>> > >>> > >>> > >>> > >> > >> > >> > >> > >> > >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 17, 2006 Report Share Posted January 17, 2006 Nothing " high tech " at all. The form just has the pt's name, the month/year at the top & then rows of items labeled " type of oversight " with the date on the left side & amount of time in minutes (circled) on the other (ie, 5, 10, 15 minutes). Examples: revisions to care/completion of telephone orders, verbal communication w/ other health care provider (name, problem, action), review of labs/reports, etc . At the bottom it has a place to circle if ,30 min or > 30 min. If over 30 min for the calendar month you submit to Medicare (only for home health/hospice pt's). I do the documentation as I sign the forms, labs, etc. I've been told the 99xxx series of CPO codes can be used for private insurances but I've never had a non-Medicare pt under Hospice or Home Health. RE: BILLING - SURG PROCEDURE and MED > >>> OFFICE VISIT SAME DAY?? > >>>Date: Thu, 12 Jan 2006 08:36:03 -0500 > >>> > >>>You must have better companies there. I tried that several times & it > >> was > >>>never paid. I'm starting to think I need to pick a better state than > >> Ohio, > >>>based on others practice stories here. > >>> > >>> > >>> > >>> > >>> > >>> > >>> > >> > >> > >> > >> > >> > >> Quote Link to comment Share on other sites More sharing options...
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