New-G-Codes

New G-Code Reporting on Home Health Claims

Additional Data Required for Home Health Therapy and Nursing Visits.

Home Health claims will need to report additional and more specific data for the therapy and nursing visits on episodes beginning on or after January 1, 2011.  http://www.cms.gov/transmittals/downloads/R824OTN.pdf.

Currently Home Health claims report the following existing HCPCS codes for Therapy visits:

  • G0151 – Physical Therapists
  • G0152 – Occupational Therapists
  • G0153 – Speech Language Pathologists

These codes are being updated to include descriptions which indicate these services are provided by a “qualified” physical or occupational therapist or speech language pathologist.

Additionally, two new G-codes are being added to incorporate the reporting of physical therapy and occupational therapy services provided by a “qualified therapy assistant”:

  • G0157 – Services performed by a qualified physical therapist assistant
  • G0158 – Services performed by a qualified occupational therapist assistant.
  • Furthermore, three additional G-codes are being added to establish delivery of therapy maintenance programs by “qualified” therapists:
  • G0159 – Services performed by a qualified physical therapist to establish or deliver a physical therapy maintenance program
  • G0160 – Services performed by a qualified occupational therapist to establish or deliver an occupational therapy maintenance program
  • G0161 – Services performed by a qualified speech-language pathologist to establish or deliver a speech-language pathology maintenance program.

Finally, this update includes a revision of existing codes for skilled nursing services, and the addition of three new G-codes to report the management and evaluation of the care plan, observation of the patient condition, and training and education of patient/family/caregivers.

  • G0154 – Direct skilled services of a LPN or RN
  • G0162 – Skilled services by an RN only, for management and evaluation of the plan of care
  • G0163 – Skilled services by LPN or RN, for observation and assessment of patient’s condition
  • G0164 – Skilled services by LPN or RN, in training and/or education of patient, family member or caregiver.

CMS has clarified they recognize the nurse or therapist may provide more than one of these new codes in the course of a single visit; however, the HHA must not report more than one G-Code per visit regardless of the variety of services provided during the visit.  The G-Code reported should reflect the service for which the clinician spent most of their time.

Also important to note: these changes do NOT reflect changes in Hospice reporting even though the descriptions for the codes indicate “Hospice” as well.

January 3, 2011

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