Posted on Friday, December 2, 2016 1:22 PM
All clinicians and billers must be aware that CMS is adding new G codes to show whether skilled services are delivered by RNs or LPNs. Failure to use these new codes could result in claims rejections.
The new codes in Change Request 9736 were announced by CMS, which were released November 10. The National Association for Home Care & Hospice (NAHC) voiced their concerns that agencies and vendors will have only two weeks to prepare for these new G codes.
CMS did not mention within the PPS rule that this was forthcoming, says Mary Carr, NAHC’s vice president for regulatory affairs.
The new G codes should be used on dates of service on or after January 1, CMS says.
According to the federal Medicare agency, there are beliefs that it will help make better calculations for the annual recalibration of home health case-mix weights.
The four new G-codes include the following:
• G0493
• G0494
• G0495
• G0496
CMS has the ability to separate G codes for therapists and therapist assistants when doing its calculations, but when G1063 and G1064 are examined, “CMS has to assume a certain percentage are performed by an RN versus an LPN.”
Last year, CMS divided G0154, the G code for “Direct skilled nursing services of a licensed nurse (LPN or RN) in the home health or hospice setting,” into two codes — G0299 and G0300 (HHL 11/2/15). CMS believes it would be appropriate to replace G1063 and G1064 “as well so that there is no longer a need to use an assumption in calculating the cost per episode when those two services are performed, allowing for increased payment precision.”
Prepare for the new G codes by doing the following:
• Make sure clinicians actually identify if the visit was performed by an RN or LPN
• Educate billers about the new codes
• Contact your vendors
Corridor’s Coding Services offers ICD-10 coding, multi-level OASIS reviews, Clinician documentation review, as well as trends and reporting. Contact us to learn more.
For the full article, please see the December 5, 2016 Home Health Line Edition.
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