How To Use HCPCS Code G2003

HCPCS code G2003 describes a moderate (45 minutes) in-home visit for a new patient post-discharge. This code is specifically used in a Medicare-approved CMMI model and is applicable for services provided within a beneficiary’s home, domiciliary, rest home, assisted living, and/or nursing facility within 90 days following discharge from an inpatient facility. It is important to note that this code can only be used a maximum of 9 times.

1. What is HCPCS G2003?

HCPCS code G2003 is used to identify a specific type of in-home visit for a new patient who has been discharged from an inpatient facility. The visit duration is moderate, lasting for approximately 45 minutes. It is important to mention that this code is only applicable in a Medicare-approved CMMI model.

2. Official Description

The official description of HCPCS code G2003 is “Moderate (45 minutes) in-home visit for a new patient post-discharge. For use only in a Medicare-approved CMMI model.” The short description for this code is “Post-d/c h vst new pt 45 m.”

3. Procedure

1. The healthcare provider will schedule an in-home visit with a new patient who has recently been discharged from an inpatient facility.
2. During the visit, the provider will assess the patient’s medical condition, review their medical history, and perform any necessary examinations.
3. The provider will also discuss the patient’s post-discharge care plan, including medication management, follow-up appointments, and any necessary lifestyle modifications.
4. If required, the provider may provide education and counseling to the patient and their family members regarding their condition and self-care.
5. Documentation of the visit, including the patient’s medical history, examination findings, and any interventions or recommendations, should be recorded.

4. When to use HCPCS code G2003

HCPCS code G2003 should be used when a healthcare provider is conducting a moderate (45 minutes) in-home visit for a new patient who has been discharged from an inpatient facility. It is important to ensure that the visit is within 90 days following the patient’s discharge and that it does not exceed a total of 9 visits.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G2003, healthcare providers should ensure that the following documentation requirements are met:

• Documentation of the patient’s medical history, including the reason for the inpatient stay and any relevant diagnoses.
• Documentation of the in-home visit, including the duration of the visit, the services provided, and any interventions or recommendations made.
• Documentation of the patient’s post-discharge care plan, including medication management, follow-up appointments, and any necessary lifestyle modifications.

6. Historical Information and Code Maintenance

HCPCS code G2003 was added to the Healthcare Common Procedure Coding System on January 01, 2019. As of now, 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

HCPCS code G2003 is payable by Medicare. The pricing indicator code for this code is 13, which means that the price is established by carriers. The multiple pricing indicator code is A, indicating that it is not applicable as HCPCS priced under one methodology. It is important for healthcare providers to verify coverage and reimbursement policies with Medicare or other insurers.

8. Examples

Here are five examples of scenarios where HCPCS code G2003 should be billed:

1. A patient is discharged from a hospital and requires a 45-minute in-home visit for assessment and post-discharge care planning.
2. A new patient is discharged from a nursing facility and needs a moderate in-home visit to review their medical history and develop a post-discharge care plan.
3. An individual is discharged from an assisted living facility and requires a 45-minute in-home visit to assess their condition and provide education on medication management.
4. A patient is discharged from a rest home and needs a moderate in-home visit for examination and counseling regarding their post-discharge care.
5. A new patient is discharged from a domiciliary and requires a 45-minute in-home visit for a comprehensive assessment and development of a post-discharge care plan.