Understanding G Codes - c.ymcdn.comc.ymcdn.com/.../resource/resmgr/2017_Spring_Conference/v2_G_code… · ©Pathway Health 2017 Understanding G Codes Lennetta Reynolds RN MSN Consultant

©Pathway Health 2017

Understanding G Codes

Lennetta Reynolds RN MSN

Consultant

[email protected]

©Pathway Health 2017 2

Home Health 2017 G Codes


• 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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G codes – Accurately report to CMS what services were provided.

Purpose

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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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New codes effective 01-01-17

G0493 - RN

G0494 - LPN

G0495 - RN

G0496 - LPN

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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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G0494 LPN O&A

Use the guidelines as for G0493.

G0494

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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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G0496 – LPN training and education

Follow guidelines for G0495

G0496

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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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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


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

authorization of Pathway Health.

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Documents

Understanding G Codes - c.ymcdn.comc.ymcdn.com/.../resource/resmgr/2017_Spring_Conference/v2_G_code… · ©Pathway Health 2017 Understanding G Codes Lennetta Reynolds RN MSN Consultant