Hospice Coding

May 1, 2007

A patient residing in a nursing home signed into hospice care. What procedure code and modifier do I use for recertification and care plan oversight?

Question: A patient residing in a nursing home signed into hospice care. What procedure code and modifier do I use for recertification and care plan oversight?

Answer: The following response was prepared by Daniel Maison, MD, FAAHPM, vice president for medical services, Treasure Coast Hospices:

First, as a point of clarification, if you have any relationship with the hospice in question, submit all billing through the hospice. This includes if the physician is employed, contracted, or even volunteers for the hospice. If you do not fall into any of the above categories, bill Medicare Part B.

In terms of codes to use for nursing home patients undergoing recertification, there is no specific code. The code, like all other nursing home visits, should be determined by:

  • Is it an “Initial Nursing Facility Visit” for this patient or a “Subsequent Nursing Facility Visit?”

  • The type of history, exam, and medical decision making involved in the visit. A visit coded at 99308 would be a subsequent nursing facility visit that met two of the following three criteria:

  • Expanded problem-focused interval history;

  • Expanded problem-focused exam;

  • Low complexity of decision making.

According to the CPT 2007 manual from the AMA, there are two codes specific for hospice Care Plan Oversight: 99377 and 99378. Assuming you have met the criteria to bill for care plan oversight, use 99377 when that activity takes between 15-29 minutes. Use 99378 when it takes 30 minutes or longer.