2. LHHC

3.  At the completion of this course, the learner will: 1. Identify why G-Codes are necessary 2. Identify the G-Codes necessary and the frequency of occurrence for the patient at Start of care; resumption of care; and recertification. 3. Determine the action required by the caregiver to carry out the intended interventions 4. Discuss the primary reason for the patient visit and the determination of the appropriate G-Code for reimbursement

4.  G-Codes:  What are they?  When do you use them?  How do you put it into the computer?  Intervention setup at SOC, Recertification and resumption of care  Documentation using interventions  WEBHHA Demonstration  Questions?

5.  Claims must report all home health services provided to the beneficiary within the episode.  Each service must be reported in line item detail.  Determined by the clinician.

6. In cases where more than one nursing or therapy service is provided in a visit, the HHA must report the G-code which reflects the primary reason for the visit. For instance if direct skilled nursing services are provided, and the nurse also provides training/education of a patient or family member during that same visit, we would expect the HHA to report the G-code which reflects primary reason for the visit.

7. G0154 : Direct skilled services of a licensed nurse. G0163: Skilled services of a licensed nurse for observation and assessment of the patient’s condition. G0164: Skilled services of a licensed nurse in the training and/or education of a patient, caregiver or family member.

8.  Observation and assessment of the patient's condition by a nurse is reasonable and necessary when  the likelihood of change in a patient's condition requires skilled nursing personnel  to identify and evaluate the patient's need for possible modification of treatment or initiation of additional medical procedures  until the patient's treatment regimen is essentially stabilized (without change at one or more episodes).

9.  Where a patient was admitted to home health care for skilled observation because there was a reasonable potential of a complication or further acute episode but… did not develop a further acute episode or complication, the skilled observation services are… still covered for three weeks or so long as there remains a reasonable potential for such a complication or further acute episode.

10. 40.1.2.4 - Administration of Medications 40.1.2.6 - Nasopharyngeal and Tracheostomy Aspiration 40.1.2.7 - Catheters 40.1.2.8 - Wound Care: Care of wounds, (including, but not limited to, ulcers, burns, pressure sores, open surgical sites, fistulas, tube sites, and tumor erosion sites) when the skills of a licensed nurse are needed to provide safely and effectively the services necessary to treat the illness or injury, is considered to be a skilled nursing service. 40.1.2.9 - Ostomy Care

11. Teaching and training activities that require skilled nursing personnel to teach a patient, the patient's family, or caregivers how to manage the treatment regimen would constitute skilled nursing services.

12.  Perform interventions will prompt G0154  Assess interventions will prompt G0163  Instruct interventions will prompt G0164

13. INTERVENTIONS YOU SHOULD ALWAYS CHOOSE FOR THE 485 O=One time only, W=Weekly, E=Every Assess PerformInstruct Patient History:OWEOWEOWE ?(specify disease process/processes) disease process, management, symptoms to report to physician. ?All systems with emphasis on (specify items related to primary diagnosis and comorbidities) ?Medication regime, () new, () changed medications. ?Purpose, dose, time, side effects, interactions, adverse effects, and methods to monitor effectiveness, of medications. ?Pulse oximeter reading prn to assess for s/s respiratory distress or assess respiratory function. NOManagement and evaluation of NEVER the plan of care.

14.  If more than one box is checked  (Perform, Assess, Instruct)  Prompt: text box: “Why did you select this skill as the primary purpose for this visit?____________”)  Primary reason!

15. Please enter the date(mm/dd/yyyy) of next scheduled MD visit: OR If UNKNOWN, Reason ** CONFIRM DOCUMENTATION ACCURACY WITH E-SIGNATURE ** E-SIGN(w/pin) 04- Admission 07-Professional Care Visit/HT Peak 38- Addendum Visit 52- Salaried Employee Visit 80- Telemed Visit You MUST select the specialized skill that was the PRIMARY purpose for this visit AND input a reason for selecting that skill as the PRIMARY purpose(200 char max). Description of specialized skill Direct services of a skilled nurse performing (Injections, IV's, Tube feedings, Suctioning, Catheters, Complex wound care, Ostomy care, Venipuncture). REASON: Services of a skilled nurse for the Observation and Assessment of the patient's condition. REASON: Services of a skilled nurse to instruct, train and/or educate a patient or family member. REASON:

16.  Questions?