Home health billers need to look out for a new condition code for reporting episodes with no skilled visits.
 
The new condition code, 54, indicates that the agency provided no skilled services during the billing period, but the agency has documentation on file of an allowable circumstance, such as an unexpected inpatient admission, CMS writes in a MLN Matters article, released Feb. 5. The new code 54 is effective July 1 and is defined as “No skilled HH visits in billing period. Policy exception documented at the HHA.”
 
The code is designed to streamline claims processing for both the payer and provider, CMS says. Claims without skilled visits that are submitted without the new condition code will be returned to the provider.
 
The code will allow agencies to add any accidentally omitted skilled services to the claim; submit the claim as non-covered, if appropriate; or append the new condition code, CMS says. This will prevent unnecessary reviews and denials for agencies and allow Medicare to better target medical review resources.
 
Note that in order to be eligible to receive Medicare home health services the beneficiary must have a skilled need that requires intermittent services from a nurse, PT, SLP, etc.
 
A Jan. 30, 2015 MLN Matters article laid out CMS’ revisions to Original Medicare systems to return to the provider any claims for episodes that are the first episode in a sequence of episodes or are the only episode of care received by a beneficiary for which patient eligibility for the home health benefit has not been established, CMS says.
 
But enforcing this requirement on claims for subsequent episodes could not be automated using previously existing codes, CMS says.
 
HCPCS edits for defibrillator services and more
Also, HCPCS codes G0299 and G0300 used to describe defibrillator services for skilled nursing visits, as well as a hospice revenue code O55x reported with HCPCS Go154 on hospice claims have been reactivated and should not cause any adverse impact, CMS says.
 
For more on these HCPCS code edits, and to read the MLN Matters article, visit: http://tinyurl.com/jt47v8j.