Home Health & Hospice

Putting Management and Evaluation into Perspective

Homecare Insider, May 9, 2011

With the advent of the new and revised G-codes, many providers continue to struggle with the appropriate use of G0162 (Skilled Services by a RN in the Delivery of Management and Evaluation of the Plan of Care). This service is performed when the patient’s underlying condition or complication requires a RN to ensure that essential non-skilled care achieves its purpose. As with any other skilled service, it must be reasonable and necessary; the complexity of the necessary unskilled services must require the involvement of skilled nursing to promote the patient’s recovery and medical safety in view of the patient’s overall condition. Many providers falsely believe this G-code is appropriate to utilize for the admission visit. This is true only if the primary service performed during the admission visit meets Medicare coverage criteria for this service.

There are three purposes for management and evaluation of a care plan: to maintain the patient’s safety, to meet the patient’s needs, and to promote the patient’s recovery. In order to determine whether or not the patient and the service meets the criteria for management and evaluation, there should be present multiple medical diagnoses or chronic illnesses, as well as a history of complications, that put the patient at increased risk for problems if the non-skilled care plan is not properly implemented. An unstable caregiving situation must exist that makes the involvement of the nurse necessary and the involvement of the nurse is essential to ensure safe, proper implementation of the plan. When providing this service, the plan of care should include a specific order for it and must include a brief narrative from the physician describing the clinical justification of this need.

Documentation should support this service and demonstrate the need, risk factors, problems, limitations, environmental concerns, diagnoses, and history of hospitalizations or complications. It should also explain the unstable caregiving situation, the complexity of unskilled services and detail the nurse’s role throughout the care plan. Goals should be identified that reflect the patient’s safety and interventions should include assignment and supervision of caregivers, coordination of care, and communication with others involved in the patients care. It’s also important for documentation to include the absence or reduction of complications, incidents, or hospitalizations which demonstrate the patient’s response.

As with all of the G-codes, the appropriate one to use should relate, directly, to the primary service provided on each visit. It’s important to remember that there is now a nursing G-code that corresponds to each skilled service covered by Medicare.

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