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Many have not yet realized that there were additional G codes introduced that went into effect January 1, 2017. These codes were not a part of the 2017 Home Health Final Rule, but were introduced in the CR9736 issued November 10, 2016.

There were two new G codes (G0299 & G0300) that went into effect January 1, 2016 that are used to identify the Registered Nurse (RN) separately from the Licensed Practical/Vocational Nurse (LPN/LVN) for “hands on care”.  Yes, that statement is for “hands on care”.  This is an issue that many agencies have not dealt with and most do not realize.  Agencies should not be using these codes (G0299 & G0300) when the primary focus of the visit/time spent on the skill provided is something other than hands on care.  Until January 1, 2017 the G codes used for these other skills, teaching & training, observation & assessment and management & evaluation of a nonskilled care plan were:

  • G0162 (not changed) Skilled services by a licensed nurse (RN only) for management and evaluation of a non-skilled plan of care, each 15 minutes (the patient’s underlying condition or complication requires an RN to ensure that essential non-skilled care achieves its purpose in the home health episode).  This is extremely rare in Medicare home health and as you can see for RN only so no need for a new code.
  • G0163  Effect January 1, 2017, this code is replaced by G0493 RN and G0494 LPN/LVN.  Skilled services of a licensed nurse (LPN or RN) for the observation & assessment of the patient’s condition, each 15 minutes (the change in the patient’s condition requires skilled nursing personnel to identify and evaluate the patient’s need for possible modification of treatment in the home health setting).  When this observation & assessment is applicable it means that there is no other skill being provided.  Also, note that the Medicare Benefit Policy Manual states that this can be provided for a maximum of 3 weeks.  Lastly, make sure clinicians are NOT using this code for “OASIS Visits”.  Completing the OASIS/comprehensive assessment alone is NOT a covered skill.  Therefore, this code could not be used because you are only conducting an assessment.  You will need to code the skill that is provided, if the OASIS/comprehensive assessment is all that is provided the visit would not be a covered visit.
  • G0164 Effect January 1, 2017, this code is replaced by G0495 RN and G0496 LPN/LVN.  Skilled services of a licensed nurse (LPN or RN), in the training and/or education of a patient or family member, in the home health setting, each 15 minutes.  75% + of home health episodes have been found to primarily consist of teaching and training the patient or caregiver.  Example:  RN provides a wound dressing change to a patient that takes 15 minutes and then spends 30 minutes teaching & training the patient or caregiver on signs and symptoms of infection, dress change methodology and a new medication, the visit should be coded G0495 NOT G0299.

90%+ of SN visits are currently being coded as G0299 or G0300, while 75%+ of these visits are truly G0495 or G0496 visits.  Agencies should educate clinicians on this issue.  The selection of the type of visit in the EMR is what typically triggers the code on the claim.  CMS, we are convinced, is tracking this information.  If not why would they have gone to the effort of adding the additional codes for 2017?  The changes in 2016 were to accommodate the need for the separation between RN and LPN for hospice payment purposes.