Home Health & Hospice

Putting Observation and Assessment into Perspective

Homecare Insider, April 25, 2011

With the advent of the new and revised G-codes, many providers continue to struggle with the appropriate use of G0163 (Skilled Services by an RN or LPN in the Delivery of Observation and Assessment of the Patient’s Condition). This service is appropriate when the likelihood of a change in the patient’s condition requires skilled nursing personnel to identify and evaluate the patient’s need for possible modification of treatment. Many providers want to automatically utilize this G-code for admission visits when, in reality, they should only do so if this was the primary service provided during that visit. The Medicare coverage criteria defines this service as “reasonable and necessary when the likelihood of change in a patient’s condition requires skilled nursing to identify and evaluate the need for possible modification of treatment or initiation of additional medical procedures until the patient’s treatment regimen is essentially stabilized.” If complications or further acute episodes don’t occur, this service is still covered for a period of three weeks-longer if there remains a reasonable potential that they will occur.

Documentation to support this service should include a history of instability or other previous problems, pertinent assessment findings that support the potential for complications, assessment findings that support the nurse’s skills to evaluate their significance and communication of those findings to the physician, changes in the plan of care or nursing care plan, and all skilled actions and findings that support the possibility of modifications to the plan of care. Use of the G-code G0163 is appropriate when this service is the primary reason for the nursing visit.

The second audio conference in Beacon Health’s winter series, High Performance in the Revised PPS, covered the use of the new and revised G-codes, including G0163. This session is available on CD and can be used to train your staff on confusing G-codes. Learn more today!