|
43.4.3.4 Non-Face-to-Face Services
Non-Face-to-Face Medical Conferences
Procedure codes 1-99361 or 1-99362 must be used when billing for medical team conferences.
Non-Face-to-Face Clinician Supervision of a Home Health Client
Procedure codes 1-99374 or 1-99375 must be used when billing for services requiring interaction with the home health agency.
Non-Face-to-Face Clinician Supervision of a Hospice Client
Procedure codes 1-99377 or 1-99378 must be used when billing for services requiring interaction with a hospice.
Other Non-Face-to-Face Supervision
Procedure codes 1-99339 or 1-99340 must be used when billing for services requiring interaction with an independently-enrolled nurse or other provider (e.g., not an home health agency, nursing facility, or hospice provider).
Non-Face-to-Face Prolonged Services
Procedure codes 1-99358 or 1-99359 must be used when billing for prolonged services without face-to-face contact. This service is to be reported in addition to other clinician services, including E/M services at any level, or health-care professionals outside of an home health agency, hospice, or nursing facility.
Non-face-to-face prolonged services are limited to a maximum of 90 minutes once per client per provider or if one of the following significant changes in the client's clinical condition occurs:
• The client will soon be, or has recently been, discharged from a prolonged and complicated hospitalization that required coordination of complex care with multiple providers in order for the client to be adequately cared for in the home.
•Documentation of recent trauma resulting in new medical complications that require complex interdisciplinary care.
•The client has a new diagnosis of a medically complex condition requiring additional interdisciplinary care with additional specialists.
Procedure code 1-99359 must be billed for the same date of service as procedure code 1-99358.
General Requirements for Non-Face-to-Face Clinician-Directed Care Coordination Services
These services may be reimbursed for the clinician time involved in this coordination. The clinician billing the services must personally perform the services. Care coordination services delegated to or performed by others do not count towards care coordination reimbursement.
Documentation
Clinician-directed care coordination services must be documented in the client's medical record. Documentation must support the services being billed and must include a record of the clinician's time spent performing specific care coordination activities, including start and stop times. The documentation should also include a formal care plan and emergency services plan. The supporting documentation maintained in the client's medical records must be dated and include the following components and requirements:
•Problem list.
•Interventions.
•Short-term and long-term goals.
•Responsible parties.
Client medical records are subject to retrospective review.
Payment is made for care coordination to a clinician providing post-surgical care during the postoperative period only if the care coordination is documented to be unrelated to the surgery.
Non-Face-to-Face Care Plan Oversight
The clinician who bills for the care plan oversight must be the same clinician who signed the POC in the home or domiciliary (procedure codes 1-99339 and 1-99340), home health agency (procedure codes 1-99374 and 1-99375), hospice (procedure codes 1-99377 and 1-99378), or nursing facility (procedure codes 1-99379 and 1-99380).
Procedure code 1-99339 is denied if billed on the same date of service by the same provider as procedure code 1-99340.
Procedure code 1-99374 is denied if billed on the same date of service by the same provider as procedure code 1-99375.
Procedure code 1-99377 is denied if billed on the same date of service by the same provider as procedure code 1-99378.
Procedure code 1-99379 is denied if billed on the same date of service by the same provider as procedure code 1-99380.
Care plan oversight services may be reimbursed for the clinician time involved in this coordination. The clinician billing the services must personally perform the services. Care coordination services delegated to or performed by others do not count towards care coordination reimbursement.
Only two clinician-directed care plan oversight services (procedure codes 1-99339 or 1-99340, 1-99374 or 1-99375, 1-99377 or 1-99378, and 1-99379 or 1-99380) are reimbursed every six months.
Payment is made only to one clinician per client per calendar month for procedure code 1-99374 or 1-99375.
Other
The clinician may not have a significant financial or contractual relationship with the home health agency as defined in 42 CFR §424.
The clinician may not be the medical director or employee of the hospice and may not furnish services under arrangements with the hospice, including volunteering.
Medical Team Conference
One medical team conference (procedure code 1-99361 or 1-99362) may be reimbursed every six months when the coordinating clinician attests that they are providing the medical home for the client. The coordinating clinician may be the client's primary care provider or a specialist.
Additional medical team conferences may be considered with documentation of a change in the client's medical home.
The medical team conference time must be documented in the client's record.
|
