Local Coverage Article Billing and Coding

Billing and Coding: Hospice Cardiopulmonary Conditions

A56610

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Contractor Information

Article Information

General Information

Article ID
A56610
Article Title
Billing and Coding: Hospice Cardiopulmonary Conditions
Article Type
Billing and Coding
Original Effective Date
06/06/2019
Revision Effective Date
06/11/2020
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

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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

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

CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 11, §30.2 Payment Rates, §30.2.2 Service Intensity Add-on (SIA) Payments, §30.3 Data Required on the Institutional Claim to A/B MAC (HHH)

Title XVIII of the Social Security Act, §1814(i) Payment for Hospice Care

Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Hospice Cardiopulmonary Conditions L34548.

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

Group 1 Paragraph

While there are no specific ICD-10-CM codes for end stage cardiopulmonary conditions, the ICD-10-CM code describing the most relevant illness, disorder, or injury contributing to the prognosis of 6 months or less should be coded.

Group 1 Codes

N/A

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

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
06/11/2020 R3

Under CMS National Coverage Policy Title XVIII of the Social Security Act, §1814(i) Payment for Hospice Care was added. Regulations unrelated to billing and coding were removed and added to related Hospice Cardiopulmonary Conditions L34548 Local Coverage Determination (LCD). Under Associated Contract Numbers, 10211 was removed, as it was inadvertently added in a previous revision. Formatting, punctuation and typographical errors were corrected throughout the Article.

10/10/2019 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 Hospice Cardiopulmonary Conditions L34548 LCD and placed in this article.

 

06/06/2019 R1

All coding located in the Coding Information section has been removed from the related Hospice Cardiopulmonary Conditions L34548 LCD and added to this article.

 

Associated Documents

Related Local Coverage Documents
LCDs
L34548 - Hospice Cardiopulmonary Conditions
Related National Coverage Documents
N/A
Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
N/A
Public Versions
Updated On Effective Dates Status
06/01/2020 06/11/2020 - N/A Currently in Effect You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • Hospice
  • Cardiopulmonary