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G-Code Transmittal – The New and Revised G-Codes

The New and Revised G-Codes and More Specific Information Sought by CMS Effective 1/1/11

http://www.coms.gov/transmittals/downloads/R824OTN.pdf

CMS is seeking more specific information regarding who is visiting the patient, ie; a PT or a PTA or an OT or COTA. In addition, they are seeking to categorize skilled nursing visits into four categories: direct skilled nursing care, management and evaluation, observation/assessment, and training/education.

What Could This Mean to a Home Health Agency?

It means that now more than ever documentation MUST support the visit TYPE and that visit TYPE had best support the POC. If a patient’s visit required education and training and this is the fifth education/training visit, it begs the question: “when is the clinician going to modify the teaching; content or method?” Visit notes will need to clearly justify the visit and show the value as it relates to the orders/goals of the POC. Now, for an auditor, it will be easier to see two or three recertifications of a chronic disease and pull out visits by type and ask specific questions. It will make it easier to deny visits. Remember, an episode doesn’t need to be fully denied, just having  5 of 14 visits denied could realize a $1000 episodic loss, depending on the patient HIPPS/HHRG.

As to therapy, now agencies can no longer have a qualified PT open a case and in effect turn it over to an assistant.  Most agencies do not do this but, there have been cases. In addition, in specific cases, would having a qualified therapist vs an assistant have made a difference in patient outcome? This will be reviewed. CMS believes it is paying for qualified therapy and expects to see the results of having the higher educated therapist actively involved with the patient’s care. (This is one reason for the mandated qualified therapist to functionally assess the patient on the 13th and 19th therapy visit.  This is set to go into effect 4/1/2011).

The clinician is to report the G-code that reflects the service provided for most of the visit.

“In addition, we are adding two new G-codes (G0-157 and G0-158) for the reporting of physical therapy and occupational therapy services provided by qualified therapy assistants”

“We are also adding and requiring three new G-codes for the reporting of the establishment or delivery of therapy maintenance programs by qualified therapists. The following are descriptions for those new G-codes, for the reporting of the establishment or delivery of therapy maintenance programs by therapists:”

So, what does the Medicare Benefit Policy Manual Chapter 7 have as outlined Skilled Therapy Services?

Section 40.2.2 Application of the Principles to Physical Therapy Services:

Example 1: “A physician orders OT for a patient who is recovering from a fractured hip and who needs to be taught compensatory and safety techniques with regard to lower extremity dressing, hygiene, toileting, and bathing. The OT will establish goals for the patient’s rehabilitation (to be approved by the physician), and will undertake teaching techniques necessary for the patient to reach the goals. OT services would be covered at a duration and intensity appropriate to the severity of the impairment and the patient’s response to treatment.”

What about skilled nursing? CMS is requiring classification of each home health visit into a specific category. The transmittal states:

“Lastly, we are revising the current definition for the existing skilled nursing services (G0-154), and requiring home health agencies (HHAs) to use G0154 only for the reporting of direct skilled nursing care to the patient by a licensed nurse (licensed practical nurse or registered nurse).”

Additionally, we are adding and requiring three new G-codes: One for the reporting of the skilled services of a licensed nurse in the management and evaluation of the care plan; another for the observation and assessment of a patient’s conditions when only the specialized skills of a licensed nurse can determine the patient’s status until the treatment regime is essentially stabilized, and another for the reporting of the training and education of a patient, a patient’s family, or caregiver:

CMS continues with the following statement:

See the Medicare Benefit Policy Manual Chapter 7 40.1.2.1 outlines “Observation and Assessment of the Patient’s Condition When Only the Specialized Skills of a Medical Professional Can Determine Patient’s Status.”

From the segmentation of the visit types, one can see that documentation becomes even more important. Documentation needs to be specific and congruent with the POC orders and goals based on the SOC OASIS integrated assessment. There needs to be adequate support for the visit type in relation to the expected and achieved outcomes.

Summary Sheet

These G-codes remain the same:

If you would like to purchase for your convienence a laminated two sided Nursing and Therapy G Code Reference Guide. Visit the links below.

G Code Therapy Guide

G Code Nursing Guide

G Code Video Link

Select Data
YouTube

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2 Responses to “G-Code Transmittal – The New and Revised G-Codes”

  1. irina maslovsky says:

    I’M CONFUSED ABOUT USING THE CODE G0162 (RN ONLY).
    IF IT’S THE CODE TO USE FOR INITIAL ASSESSMENT AND FILLING OUT OASIS, SINCE ONLY RN ALLOWED TO DO COMPREHENSIVE POC.
    GIVE ME AN EXAMPLE TO USE G0162 CODE IN HOME HEALTH SETTING. THANKS, IRINA

  2. Lynda says:

    Please help me understand. Does this mean that in the home health setting,the G162 is for an initial evaluation of care, G163 for recertification, and G164 for education and getting the patient ready for discharge.
    Thanks

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