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• Identify the purpose of G codes in home care.
• List the 2017 policy code changes
• Differentiate two different codes for RN’s and LPN’s
Objectives
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Effective 01-01-17
Codes G0162 and G0164 are retired.
Change request 9736.
Ensure your billing staffs are aware of the changes and software reflects changes.
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The new codes are required to more accurately account for the cost of services and resource utilization.
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Prior to 01-01-17 the only codes that distinguished between RN and LPN visits were G0163 and G0164 for direct skilled nursing services.
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Separating the cost for RN and LPN visits is beneficial in understanding resource utilization related to skilled nursing services for future policy decisions.
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Only one code may be used per visit even if other care provided is reflected in the G codes.
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Report the primary reason for the home care visit. Typically where the was the most time was spent.
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Can be determined ONLY at the end of the visit ONLY by the nurse who made the visit.
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Documentation must support the visit type and that visit type supports and follows the Plan of Care (POC).
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Visit notes need to clearly justify the visit and show the value as it relates to the orders/goals of the POC.
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G0493
Skilled services of a registered nurse (RN) for the observation and assessment of the client’s condition, each 15 minutes.
G0493
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G0494
Skilled services of a licensed practical nurse (LPN) for the observation and assessment of the client's condition, each 15 minutes.
G0494
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G0495
Skilled services of a registered nurse (RN), in the training and/or education of a client, family member, caregiver in the home health setting, each 15 minutes.
G0495
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G0496
Skilled services of a licensed practical nurse (LPN), in the training and/or education of a client, family member, caregiver in the home health setting, each 15 minutes.
G0496
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G0493 – RN O & A
Identify & eval. need for possible modification of treatment.
Response to medications and treatment?
G0493
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Must be a reasonable potential for change in condition that requires SN to identify & eval. need for modification of tx. or initiation of medical procedures or medications.
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Covered 3 weeks or as long as reasonable potential for complication or further acute episode.
Greater than 3 weeks: Document as above.
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S/S for continued care
• Resp. changes
• Weight changes
• Unstable vitals
• Unstable labs
• Drug toxicity
Examples
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Do not use when there is no change in tx. when history of fluctuating signs/symptoms have not required a change in prescribed treatment.
Guidelines
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G0495 RN
Training &/or education.
Require SN to teach client, family, caregiver to manage treatment regime.
G0495
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Determine the needs early on.
Determine family and/or caregiver level of support and availability along with their level of knowledge.
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To assist in determining number of visits consider -
Is it initial training/education or reinforcement or building on previous teaching??
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• Medications
• Diabetes education
• Wound care
• Transfer assistance
• Pressure ulcer prevention
Examples
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Re-training and/or teaching may be necessary and appropriate if change in procedure or change in condition that requires it.
Guidelines
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After reasonable time if client, family or caregiver will not be trained or not be able to be trained then training and/or education is not reasonable or necessary. Document reasons.
Guidelines
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• http://form-allreview.rhcloud.com/irs/new-medicare-g-codes-for-2017-home-health/
• http://info.kinnser.com/rs/010-FKU-440/images/UnderstandingGcodes-KinnserTipSheet.pdf
• http://www.selectdata.com/g-codes-home-health-hospice
References
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