Special Needs Indirect Supervision Procedures

When a staff member stands in for a pediatrician and performs a low level service also called a Care Plan Oversight, how that reimbursement works for those procedures can be confusing. In order to correctly bill services, there are certain policies that should be followed. The steps for billing indirect supervision can be broken down into the three basic steps.

Getting the coding right is the first step. The medical billing current procedural terminology codes 99375-99380 should only be used in certain instances. These codes represent non face-to-face visits by pediatricians for special needs children. There are firm instances when it is acceptable to do medical billing for this care plan oversight (CPO): amendment of care plans, review of patient status, review of lab work, and phone calls to assess condition with guardians.

In 2006, the CPO medical billing current procedural terminology codes will be expanded, however, they may only be used in three instances. First, the patient should be under a home health agency for care. This is when the medical billing codes 99374 and 99375 are used. Second, the patient is in the care of a hospice (99377 or 99378. The third instance when a CPO medical billing code is appropriate is when the patient is in a nursing facility with codes 99379 or 99380.

Get your monthly minutes right. To find the exact code to use in medical billing, you must use 30-minute increments on the CPO codes. For minutes 15-29, you use the medical billing codes 99374, 99377, and 99379. If the services were 30 minutes or more, than you would use the codes 99375, 99378, or 99380.

View all Articles by: Melissa Clark, CCS-P