Care Plan Oversight --> was Nursing Home vs Office Codes RVU's --> better pay seeing them in the nursing home?

[Guest guest]

Some info below on CPO.

But it hints that Medicare won't cover it.

Anyone with success getting paid by Medicare?

Noridian Medicare says...suggesting you can't bill Medicare for the 99379, but can use this activity of CPO to upgrade the billing in the office.

https://www.noridianmedicare.com/p-medb/news/fees/docs/2007/2007_bundled_b.pdf

Locke, MD

===================================================

http://www.aafp.org/fpm/20060700/coding.html

Communicating with nursing home staff

Q Can I use care plan oversight codes for my communications with nursing home staff regarding the management of my patients there?

A Medicare does not separately reimburse for services related to communication with nursing home staff. These services are included in the E/M services provided to the patient. Some private payers might reimburse separately for these services if they are the primary payer, but it is unlikely that many nursing home residents have private insurance as a primary payer. If the private payer is secondary to Medicare, check with the payer to determine the coverage policy. The codes for billing private payers for physician supervision of a nursing facility patient are 99379 and 99380.

====================================================

http://www.aafp.org/fpm/20030600/27time.html

Care plan oversight: For services relating to home care, use 99374 for 15 to 29 minutes and 99375 for 30 minutes or greater. For services relating to hospice care, use 99377 for 15 to 29 minutes and 99378 for 30 minutes or more. For services relating to nursing facility care, use 99379 for 15 to 29 minutes and 99380 for 30 minutes or more.

========================================

This is dated, but probably hasn't changed...it's from 1999.

http://www.aafp.org/fpm/991000fm/coding.html

Care plan oversight

Q: Can 99374 be used for completion of extensive forms for a patient who is in or being placed in a nursing home? There is no patient contact; we are only reviewing information and documentation from our records and completing a form from that information.

A: Per CPT, code 99374 may not be used for nursing-facility patients. It is specifically for care plan oversight of a patient "under care of home health agency." However, two codes are designated for care plan oversight of nursing facility patients: 99379 and 99380. Like 99374, these two codes cover "regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of related laboratory and other studies, communication (including telephone calls) with other health care professionals involved in patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy ... ."

==============================================

http://www.acponline.org/journals/news/jan-feb06/codes.htm

Home, domiciliary or rest home care plan oversight services

CPT established two new codes to describe physician supervision of a patient—when the patient is not present—who resides in his or her home, a domiciliary or a rest home, including an assisted living facility.

The new codes, 99339-99440, supplement existing CPT codes that describe physician care plan oversight of patients who receive home health care (99374-99375), are enrolled in a hospice (99376-99377) or live in a nursing facility (99379-99380). (The CPT introductory text to these new codes states that physicians should not use them with codes 99374-99380.)

The two new codes describe the same range of services and follow the same guidelines as the CPT care plan oversight service codes, 99374-99380. The new codes, along with the seven in the 99374-99380 series, all describe the following physician work:

development and/or revision of care plans;

review of subsequent reports of patient status;

review of related laboratories and other studies;

treatment-related communications with other health care professionals and other decision makers;

integration of new information into the treatment plan; and/or

adjustment of medical therapy.

Use the new 99339-99400 codes to report care oversight provided to children and adults with special health needs. You should also use these codes when coordinating the medical care management with other medical and non-medical providers for patients with chronic medical conditions.

ACP is in the process of determining whether Medicare will make a separate payment this year for services reported with these two new codes.

===================================