Understanding G Codes. Lennetta Reynolds RN MSN Consultant

Transcription

1 Understanding G Codes Lennetta Reynolds RN MSN Consultant lennetta.reynolds@pathwayhealth.com

2 Home Health 2017 G Codes 2

3 OBJECTIVES OBJECTIVES 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 3

4 Effective Codes G0162 and G0164 are retired. Change request Ensure your billing staffs are aware of the changes and software reflects changes. 4

5 PURPOSE G codes Accurately report to CMS what services were provided. 5

6 The new codes are required to more accurately account for the cost of services and resource utilization. 6

7 Prior to the only codes that distinguished between RN and LPN visits were G0163 and G0164 for direct skilled nursing services. 7

8 Separating the cost for RN and LPN visits is beneficial in understanding resource utilization related to skilled nursing services for future policy decisions. 8

9 Only one code may be used per visit even if other care provided is reflected in the G codes. 9

10 Report the primary reason for the home care visit. Typically where the was the most time was spent. 10

11 Can be determined ONLY at the end of the visit ONLY by the nurse who made the visit. 11

12 Slide Title Here Documentation must support the visit type and that visit type supports and follows the Plan of Care (POC). 12

13 Visit notes need to clearly justify the visit and show the value as it relates to the orders/goals of the POC. 13

14 New codes effective G RN G LPN G RN G LPN 14

15 G0493 Skilled services of a registered nurse (RN) for the observation and assessment of the client s condition, each 15 minutes. 15

16 G0494 Skilled services of a licensed practical nurse (LPN) for the observation and assessment of the client's condition, each 15 minutes. 16

17 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. 17

18 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. 18

19 G0493 RN O & A Identify & eval. need for possible modification of treatment. Response to medications and treatment? 19

20 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. 20

21 Covered 3 weeks or as long as reasonable potential for complication or further acute episode. Greater than 3 weeks: Document as above. 21

22 EXAMPLES S/S for continued care Resp. changes Weight changes Unstable vitals Unstable labs Drug toxicity 22

23 GUIDELINES Do not use when there is no change in tx. when history of fluctuating signs/symptoms have not required a change in prescribed treatment. 23

24 G0494 G0494 LPN O&A Use the guidelines as for G

25 G0495 G0495 RN Training &/or education. Require SN to teach client, family, caregiver to manage treatment regime. 25

26 Determine the needs early on. Determine family and/or caregiver level of support and availability along with their level of knowledge. 26

27 To assist in determining number of visits consider - Is it initial training/education or reinforcement or building on previous teaching?? 27

28 EXAMPLES Medications Diabetes education Wound care Transfer assistance Pressure ulcer prevention 28

29 GUIDELINES Re-training and/or teaching may be necessary and appropriate if change in procedure or change in condition that requires it. 29

30 GUIDELINES 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. 30

31 G0496 G0496 LPN training and education Follow guidelines for G

32 References om/irs/newmedicare-g-codesfor-2017-homehealth/ com/rs/010-fku- 440/images/Under standinggcodes- KinnserTipSheet.pd f 32

33 Reference ata.com/g-codeshome-healthhospice 33

34 This presentation is copyrighted information of Pathway Health. This presentation is not to be sold or reused without written authorization of Pathway Health. Pathway Health