For dates of service on or after January 1, 2017, home health agencies will have four new G-codes to contend with for skilled nursing services. These new codes will replace retiring codes G0163 and G0164. The new codes are:

G0493 – Skilled services of a registered nurse (RN) for the observation and 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 or hospice setting).

G0494 – Skilled services of a licensed practical nurse (LPN) for the observation and 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 or hospice setting).

G0495 – Skilled services of a registered nurse (RN), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes.

G0496 – Skilled services of a licensed practical nurse (LPN), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes.

Disposable Negative Pressure Wound Therapy

Another big billing change is when using disposable Negative Pressure Wound Therapy (NPWT) devices for a patient receiving services under a home health episode. The two codes for disposable NPWT services are:

97607 – Negative pressure wound therapy, (e.g., vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters.

97608 – Negative pressure wound therapy, (e.g., vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters.

If the only service the patient is receiving in the visit is the NPWT with the disposable device, the HHA would bill using type of bill 034x with revenue code 0559 or 042X or 043X and either HCPCS code 97607 or 97608. No aspect of this visit would be reported on the home health PPS claim type of bill 032x.

If the patient is receiving NPWT with the disposable device along with other billable home health services, the time performing the NPWT services and the time performing the billable home health services must be recorded separately. The home health services with the adjusted number of units will go on the home health claim (type of bill 032x) and the NPWT services will be billed as indicated above.

Changes in Outlier Payment Calculations

Outlier costs had been calculated using a per-visit analysis. CMS had found this did not take into consideration very short or extremely long visits and even created a “financial disincentive for providers to treat medically complex beneficiaries that require longer visits.” So the methodology is changing to calculate using a cost per unit rate instead of cost per visit.

For more information on these changes, please see the Medicare Learning Network Matters Article MM9736.