HCCIntelligence™ Webinar Recording: The Most Important Billing Codes You May Not Be Using

Webinar Q and A

Pdf Summary

The document is a webinar Q&A by the HCC Institute discussing various medical billing codes and their applications, with a focus on services like prolonged care, transitional care management (TCM), advanced care planning (ACP), and chronic care management (CCM). Key points include:<br /><br />1. **Place of Service for Non-Face-to-Face Prolonged Services**: Bill according to the location of preparatory work, e.g., office/preparation time (POS 11).<br /><br />2. **Concurrent Billing for ACP and TCM**: ACP can be billed along with TCM, AWV, or CCM.<br /><br />3. **Modifier 25 for E/M Visits**: Applies to significant, separate E/M services on the same day. Providers should verify local MAC policies.<br /><br />4. **Billing G0180 with CCM and TCM**: G0180 (Home Health Certification) can be billed during the same month, but G0181/G0182 cannot overlap with CCM/TCM billing.<br /><br />5. **G0180 and G0179 for Medicare**: These codes are specific to Medicare beneficiaries, and current legislation restricts billing by APRNs until new laws pass.<br /><br />6. **Home Health Certification and Recertification Requirements**: Specific conditions needed for billing G0180 and G0179 include the patient's history, DOS on the plan of care, and physician-patient interaction records.<br /><br />7. **Documentation and Billing for Non-Face-to-Face Services**: Separate documentation for non-face-to-face time ensures clarity, and billing must be related to an E/M service.<br /><br />8. **Prolonged Services and Concurrent Care Coordination**: Services like 99358/99359 relate to the same or different day’s E/M service, and time must be tracked accurately for the day of service.<br /><br />9. **Specialist Guidelines**: Providers like NP and CPO (Care Plan Oversight) can bill under certain conditions, and correct billing of certification and recertification codes (G0180/G0179) includes physician documentation and communication.<br /><br />10. **Miscellaneous Topics**: Billing forms without patient visits, documentation for different POS, and the necessity for clear, individualized documentation during ACP to support medical necessity.<br /><br />The document encourages providers to be diligent with the evolving billing practices, staying compliant with Medicare/insurance regulations, and tailoring documentation specific to each patient's visit.

Keywords

medical billing codes

prolonged care

transitional care management

advanced care planning

chronic care management

modifier 25

home health certification

non-face-to-face services

concurrent billing

Medicare regulations