Home Health & Hospice

Nursing G-codes Continue to Confuse Clinicians

Homecare Insider, April 4, 2011

Since the January 1st effective date, the new and revised G-codes have been confusing providers. Let's take a look at some of the nursing G-codes and how they should be used.

The definition for G0154, skilled nursing services, was revised and now agencies are required to only use this code for the reporting of direct skilled nursing care to the patient by a licensed nurse. G0164 has been added and should be used to report the skilled services of a licensed nurse in the training and/or education of a patient or family member. 
The addition of G0162 and G0163 and their definitions are causing a great deal of confusion. Providers must remember that the skilled nursing services have not changed, but now those services have G-codes assigned to them. There are four Medicare-covered skilled nursing services: skilled procedures, teaching and training activities, management and evaluation of a patient's care plan, and observation and assessment.
G0162 is to be used to report skilled services by a registered nurse only for management and evaluation of the plan of care. Management and evaluation of the plan of care is a skilled nursing service payable by Medicare when the underlying condition or complication requires an RN to ensure that essential non-skilled care achieves its purpose. This skilled service has long been part of the home health benefit; however, it did not have a G-code assigned to it until now.
G0163 is to be used to report skilled services of a licensed LPN or RN for the observation and assessment of the patient's condition. Observation and assessment is a skilled nursing service when the change in the patient's condition requires skilled nursing personnel to identify and evaluate the need for possible modification of treatment.