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When reporting G0505, ensure patients fit the bill -- diagnostically

Look to your diagnosis coding to understand whether a patient fits the criteria for new cognitive-assessment code G0505 because the code does not confer blanket coverage for your elderly patients.
To get your claims through and take advantage of the high price point -- about $238 (national, non-facility) -- you must "know exactly which patients you can perform this service with," advised Lesley Manson, PsyD, clinical assistant professor with Arizona State University in Tempe, Ariz., and co-author of Integrating Behavioral Health Into the Medical Home, during a May 17 webinar on the new service that debuted Jan. 1.
The official description of G0505 shows that the service may be offered to patients with a documented history of "cognitive impairment." You could make the diagnosis during the patient's visit, or you can look to an "established diagnosis of a neurodegenerative [condition]" or of a "general medical condition causing cognitive impairment of any degree of severity," noted Manson.
That's not all. You must also establish that the patient is "at risk for further cognitive decline" or show evidence of other aspects of their daily life that may threaten their health, Manson explains. For example, you could document an "onset or worsening of another medical or surgical problem" or a "hospitalization or emergency department" visit as factor that could exacerbate a patient's condition.
Without both aspects of the diagnosis -- a history of impairment and the risk of decline or worsening conditions -- your G0505 efforts won't pass muster.
To that end, keep a keen eye on your diagnosis coding. Dozens of ICD-10 codes might fit the bill, ranging from G30.9 (Dementia Alzheimer's disease, unspecified) to F01.5 (Vascular dementia) and others. Most likely you'll reach for a general cognitive impairment code. For instance, G31.84 (Mild cognitive impairment, so stated) is "probably one of the most common codes you'll use," predicts Manson.
Other diagnoses that may fit the bill include multiple sclerosis (G35), Huntington's disease (G10), Parkinson's disease (G20) and other disease states that have a deleterious impact on cognition and mental tasks.
For more tips on reporting G0505, check out the full service requirements and tune in to the on-demand version of the webinar Simplify cognitive care: Perform dementia assessment, report new code G0505 to get paid.
Blog Tags: CMS, E/M services
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