How To Use HCPCS Code G2005

HCPCS code G2005 describes an extensive 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. The visit should last for a duration of 75 minutes and can be performed up to 9 times.

1. What is HCPCS G2005?

HCPCS code G2005 is used to identify an extensive in-home visit for a new patient post-discharge. This code is specific to the Medicare-approved CMMI model and is only applicable for services provided within a beneficiary’s home or other eligible facilities. The visit should last for a duration of 75 minutes and can be performed up to 9 times.

2. Official Description

The official description of HCPCS code G2005 is “Extensive (75 minutes) in-home visit for a new patient post-discharge. For use only in a Medicare-approved CMMI model.” The short description is “Post-d/c h vst new pt 75 m.”

3. Procedure

1. The provider begins the extensive in-home visit by reviewing the patient’s medical history and any relevant discharge summaries.
2. A comprehensive physical examination is conducted, including vital signs, assessment of the patient’s overall condition, and evaluation of any specific concerns or symptoms.
3. The provider engages in a detailed discussion with the patient regarding their post-discharge care plan, including medication management, follow-up appointments, and any necessary lifestyle modifications.
4. During the visit, the provider may perform additional diagnostic tests or procedures as deemed necessary based on the patient’s condition and medical history.
5. The provider documents all findings, assessments, and recommendations in the patient’s medical record.
6. After the visit, the provider may coordinate with other healthcare professionals involved in the patient’s care, such as specialists or home health agencies, to ensure a seamless transition and continuity of care.

4. When to use HCPCS code G2005

HCPCS code G2005 should be used when providing an extensive in-home visit for a new patient within 90 days following their discharge from an inpatient facility. This code is only applicable in a Medicare-approved CMMI model and can be used up to 9 times for the same patient. It is important to ensure that the visit lasts for a duration of 75 minutes to accurately report the service.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G2005, healthcare providers should ensure that the visit meets the criteria for an extensive in-home visit for a new patient post-discharge. Documentation should include the patient’s medical history, discharge summaries, comprehensive physical examination findings, discussions regarding post-discharge care plans, any additional diagnostic tests or procedures performed, and coordination with other healthcare professionals involved in the patient’s care.

6. Historical Information and Code Maintenance

HCPCS code G2005 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 G2005 is payable by Medicare. The pricing indicator code 13 indicates that the price for this service is established by carriers, which means it is not otherwise classified and is subject to individual determination and carrier discretion. The multiple pricing indicator code A indicates that this code is not applicable as HCPCS is priced under one methodology.

8. Examples

Here are five examples of when HCPCS code G2005 should be billed:

1. A patient is discharged from an inpatient facility and requires an extensive in-home visit for comprehensive post-discharge care planning and evaluation.
2. A new patient with complex medical needs is discharged from a nursing facility and requires an extensive in-home visit to assess their condition and develop a personalized care plan.
3. An elderly patient is discharged from an assisted living facility and requires an extensive in-home visit to review their medication regimen and ensure proper management.
4. A patient with a chronic condition is discharged from a rest home and requires an extensive in-home visit to monitor their progress and adjust their treatment plan.
5. A patient is discharged from a domiciliary and requires an extensive in-home visit to address any post-discharge complications and provide necessary support.