Local Coverage Article Billing and Coding

Billing and Coding: Home Health Skilled Nursing Care-Teaching and Training: Alzheimer's Disease and Behavioral Disturbances

A56641

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Contractor Information

Article Information

General Information

Article ID
A56641
Article Title
Billing and Coding: Home Health Skilled Nursing Care-Teaching and Training: Alzheimer's Disease and Behavioral Disturbances
Article Type
Billing and Coding
Original Effective Date
07/04/2019
Revision Effective Date
10/01/2022
Revision Ending Date
N/A
Retirement Date
N/A
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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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CMS National Coverage Policy

Federal Register Final Rule/Vol. 74, No 216, dated November 10, 2009, pp 58111-58112

CMS Internet-Only Manual, Pub 100-04, Medicare Claims Processing Manual, Chapter 10, §40.2

Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Home Health Skilled Nursing Care-Teaching and Training: Alzheimer’s Disease and Behavioral Disturbances L34562.

Coding Information

CPT/HCPCS Codes

Group 1

(2 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
G0299 DIRECT SKILLED NURSING SERVICES OF A REGISTERED NURSE (RN) IN THE HOME HEALTH OR HOSPICE SETTING, EACH 15 MINUTES
G0300 DIRECT SKILLED NURSING SERVICES OF A LICENSED PRACTICAL NURSE (LPN) IN THE HOME HEALTH OR HOSPICE SETTING, EACH 15 MINUTES

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(13 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
F03.90 Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
F03.911 Unspecified dementia, unspecified severity, with agitation
F03.918 Unspecified dementia, unspecified severity, with other behavioral disturbance
F03.92 Unspecified dementia, unspecified severity, with psychotic disturbance
F03.93 Unspecified dementia, unspecified severity, with mood disturbance
F03.94 Unspecified dementia, unspecified severity, with anxiety
G30.0 Alzheimer's disease with early onset
G30.1 Alzheimer's disease with late onset
G30.8 Other Alzheimer's disease
G30.9 Alzheimer's disease, unspecified
G31.01 Pick's disease
G31.1 Senile degeneration of brain, not elsewhere classified
G31.85 Corticobasal degeneration

ICD-10-CM Codes that DO NOT Support Medical Necessity

N/A

ICD-10-PCS Codes

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

N/A

Other Coding Information

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
10/01/2022 R3

Under ICD-10-CM Codes that Support Medical Necessity Group 1: Codes deleted F02.81 and F03.91, added F03.911, F03.918, F03,92, F03.93, F0394, and revised the description for F03.90. This revision is due to the Annual ICD-10-CM Update and will become effective on 10/1/22.

10/24/2019 R2

This article is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs and incorporate into related Billing and Coding Articles. Regulations regarding billing and coding were removed from the CMS National Coverage Policy section of the related Home Health Skilled Nursing Care-Teaching and Training: Alzheimer’s Disease and Behavioral Disturbances L34562 LCD and placed in this article.

07/04/2019 R1

All coding located in the Coding Information section has been removed from the related Home Health Skilled Nursing Care-Teaching and Training: Alzheimer’s Disease and Behavioral Disturbances L34562 LCD and added to this article.

Associated Documents

Related Local Coverage Documents
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Related National Coverage Documents
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Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
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Other URLs
N/A
Public Versions
Updated On Effective Dates Status
09/22/2022 10/01/2022 - N/A Currently in Effect You are here
10/16/2019 10/24/2019 - 09/30/2022 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • Home Health
  • Skilled Nursing Care
  • Alzheimer's Disease