Watch April MPFS Update for NGACO Code Changes With a January Twist

Ready for some retroactive MPFS changes? The next Medicare Physician Fee Schedule update may have an April 1, 2019, implementation date, but the effective date is Jan. 1, 2019. The theme for the HCPCS codes involved is Next Generation Accountable Care Organization (NGACO) Model Post Discharge Home Visits.

Remember: “MACs will not search their files to retract payment for claims already paid or to retroactively pay claims. However, MACs will adjust claims that you bring to their attention,” MLN Matters MM11163 states.

Know How to Code New-Patient In-Home Visits

The first five codes vary based on service-level/time, but the codes share this portion of their descriptors, specific to new patients: … in-home visit for a new patient post-discharge. For use only in a Medicare-approved CMMI model. (Services must be furnished within a beneficiary’s home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)

Below are the new HCPCS codes. For MPFS indicators and RVUs, Medicare crossed each new code to an existing CPT® code, which you’ll see below, too:

• G2001 (Brief (20 minutes) …)
  
  • Cross-code: 99341
  
  


• G2002 (Limited (30 minutes) …)
  
  • Cross-code: 99342
  
  


• G2003 (Moderate (45 minutes) …)
  
  • Cross-code: 99343
  
  


• G2004 (Comprehensive (60 minutes) …)
  
  • Cross-code: 99344
  
  


• G2005 (Extensive (75 minutes) …)
  
  • Cross-code: 99345.
  
  

Switch to These HCPCS Code Options for Existing Patients

The descriptors for G2006-G2013 are almost identical to G2001-G2005. The difference is that G2006-G2013 apply to existing patients instead of new patients: … in-home visit for an existing patient post-discharge. For use only in a Medicare-approved CMMI model. (Services must be furnished within a beneficiary’s home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.):

• G2006 (Brief (20 minutes) …)
  
  • Cross-code: 99347
  
  


• G2007 (Limited (30 minutes) …)
  
  • Cross-code: 99348
  
  


• G2008 (Moderate (45 minutes) …)
  
  • Cross-code: 99349
  
  


• G2009 (Comprehensive (60 minutes) …)
  
  • Cross-code: 99350
  
  


• G2013 (Extensive (75 minutes) …)
  
  • Cross-code: 99345.
  
  

Don’t miss: There’s a bit of a jump in number between the last two codes, G2009 and G2013. Keep that in mind so you don’t accidentally report G2010 (Remote evaluation of recorded video and/or images submitted by an established patient …).

Choose Between 2 Options for Care Plan Oversight

The last two new codes are for care plan oversight:

• G2014 (Limited (30 minutes) care plan oversight. For use only in a Medicare-approved CMMI model. (Services must be furnished within a beneficiary’s home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
  
  • Cross-code: 99339.
  
  


• G2015 (Comprehensive (60 mins) home care plan oversight. For use only in a Medicare-approved CMMI model. (Services must be furnished within a beneficiary’s home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility.))
  
  • Cross-code: 99340.
  
  

Update G9987 Indicators, Too

The April MPFS update also includes a correction for an existing code, G9987 (Bundled Payments for Care Improvement Advanced (BPCI Advanced) model home visit for patient assessment performed by clinical staff for an individual not considered homebound … for use only for a BPCI Advanced model episode of care; may not be billed for a 30-day period covered by a transitional care management code.)

The change is retroactive to January 1, and it adjusts the assistant surgery, co-surgeon, and team surgeon indicators to 9, showing the concept does not apply. The code started the year with 0 indicators for those elements, meaning additional payment for co/team-surgeons wasn’t permitted and assistant payment wasn’t allowed unless supported by the documentation. But based on the code descriptor, the “concept does not apply” indicator makes more sense for G9987.

What About You?

Do you report these codes? Do you think the cross-codes chosen for RVUs are a good match?

About Deborah Marsh

Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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