CPT 99509 - how billed?

[Ruth Sheets]

This question was asked as a chat questions during the May 2014 webinar. Any ideas?

Q #21: CPT code 99509 - how is this paid? for example: 8 hours = 1 unit or 15 minutes = 1 unit or 24 hours = 1 unit

 

[Ruth Sheets]

From Supercoder.com:
99509 Home visit for assistance with activities of daily living and personal care

Lay Term:
A home health provider, such as a registered nurse, or a non nursing practitioner, visits a patient to provide help with activities of daily living, or ADLs, and self care.

Clinical Responsibility:
ADLs include bathing, dressing, grooming, eating, using the bathroom, walking, and transferring from one location to another, such as from a wheelchair to the bed. The provider assists the patient with these activities, based on a care plan established with the physician, patient, and family members.

I could not find any time guidelines. It does seem unlikely that a home health provider spending 1 hour should be paid the same as one that spends 8 hours, for example.

 

[Debra Locke]

I know this is a late response by far Ruth but I will weigh in. I am actually working on a clinical review right now that involves a Home Health provider and encompasses HCPCS code services for Home Attendants thru Skilled Nursing Care.

My first guess is that unless the payor is requesting that the CPT code be used for some reason the guidelines around using the codes where the most specificity lies would be my recommendation. In this case I think the service described above would match the Home Health Aide HCPCS Code S9122 which is Home health aide or certified nurse assistant, providing care in the home; per hour

Your thoughts?
~Deb

 

[Ruth Sheets]

S9122 seems like a better choice if the payor accepts it.

Thanks for your input, Deb!

 

[Debra Locke]

I have another case coming up that may be very similar in terms of the guideline. The provider is billing for a propritetary genetic medication response panel testing using a more generic HCPCS code for a molecular pathology test, interpretation and report. There are actually three CPT codes in the path and lab section 81225-81227 that should be used if appropriate.

 

[Carolyn Heath]

Debra, what is your question in your post?