How To Use HCPCS Code G0318

HCPCS code G0318 describes a prolonged home or residence evaluation and management service provided by a physician or qualified healthcare professional. This code is used when additional time is spent beyond the total time for the primary service, which is selected using time on the date of the primary service. It is important to note that this code should not be reported on the same date of service as other prolonged services for evaluation and management.

1. What is HCPCS G0318?

HCPCS code G0318 is used to identify a prolonged home or residence evaluation and management service that goes beyond the total time for the primary service. This code is used to report each additional 15 minutes spent by the physician or qualified healthcare professional, with or without direct patient contact. It should be listed separately in addition to CPT codes 99345 and 99350 for home or residence evaluation and management services.

2. Official Description

The official description of HCPCS code G0318 is “Prolonged home or residence evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to CPT codes 99345, 99350 for home or residence evaluation and management services).”

The short description for this code is “Prolong home eval add 15m.”

3. Procedure

1. The provider begins by performing the primary evaluation and management service for the patient at their home or residence.
2. If additional time is required beyond the total time for the primary service, the provider can use HCPCS code G0318 to report each additional 15 minutes spent.
3. This additional time can be spent on activities such as reviewing medical records, coordinating care with other healthcare professionals, or providing patient education.
4. The provider may or may not have direct patient contact during this additional time.
5. It is important to list HCPCS code G0318 separately in addition to the appropriate CPT codes for home or residence evaluation and management services.

4. When to use HCPCS code G0318

HCPCS code G0318 should be used when the provider spends additional time beyond the total time for the primary service during a home or residence evaluation and management. This code is specifically used for each additional 15 minutes spent by the physician or qualified healthcare professional. It is important to note that this code should not be reported on the same date of service as other prolonged services for evaluation and management, such as codes 99358, 99359, or 99417. Additionally, HCPCS code G0318 should not be reported for any time unit less than 15 minutes.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0318, healthcare providers need to document the additional time spent beyond the total time for the primary service. This documentation should include the activities performed during this additional time, such as reviewing medical records or coordinating care. It is important to list HCPCS code G0318 separately in addition to the appropriate CPT codes for home or residence evaluation and management services.

6. Historical Information and Code Maintenance

HCPCS code G0318 was added to the Healthcare Common Procedure Coding System on January 01, 2023. As of this date, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

The coverage of HCPCS code G0318 is determined by the carrier’s judgment. Medicare and other insurers may have specific guidelines and policies regarding the reimbursement of this code. The pricing indicator code for HCPCS code G0318 is 11, which means the price is established using national RVUs (Relative Value Units). The multiple pricing indicator code for this code is A, which means it is not applicable as HCPCS priced under one methodology.

8. Examples

Here are five examples of when HCPCS code G0318 should be billed:

1. A physician spends an additional 30 minutes reviewing a patient’s medical records and coordinating care with other healthcare professionals during a home evaluation and management service.
2. A qualified healthcare professional spends an additional 45 minutes providing patient education and counseling during a residence evaluation and management service.
3. A physician spends an additional 15 minutes reviewing and interpreting diagnostic test results during a home evaluation and management service.
4. A qualified healthcare professional spends an additional 60 minutes coordinating care and communicating with the patient’s family members during a residence evaluation and management service.
5. A physician spends an additional 30 minutes discussing treatment options and obtaining informed consent from the patient during a home evaluation and management service.