So, let’s go ahead and jump in and talk about Face to Face & Home Health Cert/PT Cert.
Q: “There are some discrepancies in the office and external billing office with billing certifications signed by the doctors for: Face-to-Face visits for Home Health, Plan of Care and Physical – Occupational Therapy/Hospice. What are the proper HCPCS codes and date that should be on the certification for billing purposes?”
A: Well this maybe a mouthful, but what I was able to do is to go in and pull out some specific information that I think is going to be beneficial for you.
Different certifications fall under different timelines. For example, hospice, you can usually find a lot of information under hospice and I want you to know that if you go out and you Google this, I don’t want to say it’s self-explanatory, but there’s good information and the timelines seem to follow with the other scenarios that the person is wanting information on.
One of the codes that you’re going to get familiar with is G0337. Now, this is a HCPCS code – hospice evaluation and counseling services, pre-election – meaning that they’re deciding that the person is going on hospice. That’s probably the term that you’ll be familiar with that you’ll hear.
“The hospice must obtain verbal or written certification…” this is very important“…of the terminal illness…” So, hospice care, a person doesn’t usually go on hospice until they know that they’re at the end stages of life and they’re usually expecting life expectancy of six months. That’s kind of a standard, is what they’re thinking. Can it go longer? Absolutely it can go longer. Can it be less? Yes, it often is. But that’s the timeframe that they’re looking at. They’re looking at a possible six months window.
For that, that means the person has to be terminally ill, “no later than 2 calendar days (by the end of the third day) after the start of each benefit period (initial and subsequent)” because mind you, you’re going six months but it could go longer. “Initial certifications may be completed up to 15 days before hospice care is elected.” That means that there’s a lot of counseling that goes on here and everybody rightly so wants to make sure that this is the best for their loved one.
Face to Face Home Health – HCPCS Codes and Date Certification for Billing – Video
Now, going on hospice is really just helping the family. There’re guidelines that are different for a person on hospice versus a person that’s an inpatient even or getting home health. The hospice nurses are able to do much more for a hospice patient than a home health nurse can and a lot of that has to do with the comfort of the patient. They know in-depth what the disease process is for this patient and therefore it really is very helpful not only for the patient and their comfort but for the family members. You can think of it as it just takes away the red tape.
“The hospice election date” or the admission date when you start hospice “is January 1, 2014. The physician’s certification is dated January 3, 2014.” This is just a scenario. “The hospice date for coverage and billing is January 1, 2014. The first hospice benefit period ends 90 days from January 1, 2014.”
Now, like I was saying they usually don’t allow someone to go on hospice until they know they’re about six months, they have about six months. The certification periods go for 90 days.
“A hospice representative must make sure the required physician’s certification and a signed hospice election statement…” meaning, the family or the patient has decided to go on hospice. These have to be in the record before signing of the form, the CMS 1450.
I know a lot of you are familiar with the 1500 form, but hospice has their own billing form and that’s the CMS 1450. In this situation nobody else does this, but a stamped signature is acceptable – meaning, that the physician can use a stamp. Nobody else gets to do that anymore, stamps are out when you deal with Medicare or Medicaid. Just a heads-up with that. That’s why I added that to let you know that the information that I was looking up, because I was shocked to see that a stamped signature was accepted for these forms.
The hospice, think it in yourself “G0” that’s why I put the “G” and the “0” here, it’s a zero. These are the code ranges that you’re looking at. G0151 throughG0164 – Services delivered under an outpatient occupational therapy plan of care. So, now, we’re done with hospice and we’re talking about occupational therapy. This is going to work with physical therapy as well. There are specific codes for each of these. This was the best example I could find so that’s what I went with.
“G0151 – Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes.”Now, one thing that is different for therapists is that it’s divided up in 15-minute segments. If you’re not used to looking at physical therapy notes or occupational therapy notes, they are a whole different ball game to what you’re used to with nurse’s notes and stuff. I know a lot of people struggle with looking at them. If you have done home health, you’ll be familiar with the way they look, but they do everything in 15-minute windows and this can be very confusing when someone who’s used to looking at nurse’s notes goes in and says, “There’s no rhyme and reason to this.” That’s why it is confusing.
Then, to “G0164: Skilled services as a licensed nurse (LPN or RN), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes.” So, yes, the patient that is on hospice can still be getting occupational therapy. That’s good to know, isn’t it? It’s not like they say, “This is the end, and we are just keeping you comfortable.” No. They're doing much more than that. Again, these are the codes that you're going to be looking at.
Now, I wanted to show you a range also of the hospice services. “The following HCPCS codes will be used to report the type of service location for hospice services” and here are the definitions with them. I'm not going to read each one of those, but I want you to see that you’ve got hospice care is provided in all of these different settings: we have patient’s home/residence, assisted living facility, you got nursing long term care facility – and again, if you're not familiar, some of these sound like they would be the same and they're not. They actually are quite different.
We have a nursing facility (NF). We have a skilled nursing facility (SNF) which we abbreviate as the SNF. We have an inpatient hospital and hospice facility. You have long term care hospital (LTCH). You have inpatient psychiatric facility, and place not otherwise specified. Then last, it goes home care provided in a hospice facility – and you do see more of these, I think, even now than you used to find is where they actually have a hospice facility and they're geared towards completely keeping that person comfortable and their quality of life as high as they possibly can get it until the end of life. You will find those places out there which are wonderful and there’re specific codes for them.
”If care is rendered at multiple locations, each location is to be identified on the claim with a corresponding HCPCS code.” See the codes that we did here, if one person moves from one to another, then you're going to change your code. “For example, routine home care maybe provided for a portion of the billing period in the patient’s residence and another portion in assisted living facility. In this case, reported one revenue code, 651 line with HCPCS code Q5001…”That’s how that would be set up “…and the number of days of routine home care provided in the residence, and another revenue code 651 line with a HCPCS code Q5002 and the number of days of routine home care provided in the assisted living facility.”
Really, it’s just showing continuity of care and there're codes that show that the person has moved. Again, we’re just painting a picture, the best picture possible for not only the pay or, but we’re also dealing with statistical purposes, right? Don’t forget that.
Home Health – These are the things that you're going to be dealing with in Home Health. The nurse is going to fill out what is called an OASIS. This is a 15- to 16-page document where an RN goes out and evaluates the patient and sees if they are a candidate for home health. Now, there are rules and guidelines that have to be followed. For example, one of those would be that they can't drive. In other words, why would we be paying for a person to have a nurse come out to take care of the patient if the patient can get to the doctor?
It has to be a very difficult and strenuous problem for them to be able to get to the doctor. It’s not that they can't drive, but let’s say there is a car and they have a wife, but – we’re talking about a gentleman here – but the wife is not comfortable driving in heavy traffic or maybe the wife is working, or for whatever reason. It’s going to be very difficult for them to get the patient to the doctor into specific visits that they need and they need routine care, maybe they have diabetes. They need their toes taken care of or maybe they need their insulin injections but they can't see very good anymore because of glaucoma and they can't draw up their insulin or give it to themselves, for whatever reason that the nurse needs to come and do this.
What they're going to do is the nurse will determine if they are candidate for this and any education or physical therapy that might be appropriate for the patient or education. Then, they’ll fill out the OASIS and a plan of care will be created and this plan of care is on a 485 form. That 485 form is sent to the physician – the patient’s physician. The physician reviews it and states whether he agrees or wants to change anything on that plan of care for the patient.
Let’s say that the patient is diabetic and he wants to set the patient up on an insulin pump. So, he would, in addition, add that he wants the nurse to provide education on an insulin pump for that patient. So, he would add that and he would sign it. Thirty days for an assessment and creation of a POC and to obtain a signature. That’s your time frame.
If the nurse goes out and fills out an OASIS on January 1st, then they have 30 days to type up the plan of care, fill out the 485, get it to the doctor, have the doctor sign it, and have it back in the office 30 days. There's a window there. Sixty days of treatment for each plan of care. Just like the home health, there's a time frame. Theirs is 90 days. Well, each plan of care only last for 60 days.
If the nurse knows that our patient is not getting it, they're going to need some additional education and then she is aware of maybe there's some occupational therapy that needs to be added to this for the patient. So, she would write out a new plan of care, a new OASIS, they have to be reevaluated. The same thing starts over again, every 60 days. They have 30 days to fill out the plan of care – the 485 – get it to the doctor, the doctor signs it, and gets back to the patient. Everything is done on that 60-day window.
The CPT codes and the HCPCS codes, they're used for supplies. Again, there're a lot of supplies that are involved. If the patient is on insulin, the Home Health Agency provides the syringes and the alcohol swabs. All of that stuff is included in what the Home Health Agency gets paid to take care of that patient.
There are some helpful codes. This is a cheat sheet for…let me just show you that real quick and then we’ll go back. This is a place that I found in CMS Home Health Medicare Billing Code Sheet and it just really has a breakdown of some of the codes and here are those HCPCS codes that we had talked about, physical therapy and stuff like that. You can find that on cms.gov. This particular one I copied over to cgsmedicare.com.
Again, this is a home health and hospice and stuff, whole different ballgame, completely different thought process. The general guidelines all apply, but they have their own unique setup for codes and so it is a – I don’t want to say it’s a big business, that’s not the right term – but there's a lot of need for coders out there that are savvy with this, because again one person, just as a general coder, can't really just jump in and do this type of coding without a little extra education. There's going to be a learning curve on that.