CONSIDERATIONS Palliative Care Coverage

And Considerations

Background

Many community hospitals are responding to the needs of their patients by offering palliative care programs Typically, a Nurse Practitioner is employed to provide services which ease the condition of patients and their families enduring distressing, painful medical conditions.

Typically, a nurse practitioner providing palliative care will report a problem-focused Evaluation and Management code to report professional fees, with an ICD-10 code and documentation which supports medical necessity The difference between palliative care and hospice care is described in the following Medicare document:

Palliative Care vs Hospice Care Similar but Different (cms gov)

Palliativecarecoverageand Considerations

Frequent ly Asked Quest ions

1 The person hired t o do t he Palliat ive Care is a Nurse Pract it ioner Is t hat is a billable service?

Answ er: Services of a Nurse Practitioner are billable as professional fees, provided of course that the services billed are medically necessary and the nurse practitioner is properly enrolled with the payer.

2. Our Nurse Pract it ioner w ill be seeing bot h inpat ient s and out pat ient s in t he hospit al She m ay also be seeing pat ient s in t heir hom es

Be sure the NPis enrolled with Medicare and included under your medical group NPI with an 855B form (or on PECOS) no more than 30 days prior to the date on which the NPwill begin seeing patients.

The NPmust also update the NP?s individual Medicare enrollment (855I/PECOS) to add locations of service which include the facility and patient home visits. NPservices billed as professional fees will be reimbursed at 85%of the Medicare physician fee schedule (CAH Method II note: nurse practitioner services in the outpatient hospital setting must be billed with modifier -GFappended to the CPT® code on the UB/837i.)

Verify that the appropriate E/M codes are available with in the chargemaster, and ensure that the appropriate Place of Service codes are also reportable Typical professional fee codes would include, but not be limited to the following:

Out pat ient visit s in the clinic or hospital setting: 99202- 99215

Inpat ient s ? 99221- 99223

Hom e or dom iciliary visit s ? 99341- 99350

Typical Place of Service codes:

21 ? Hospit al Inpat ient

22 ? Hospit al Out pat ient

12 - Hom e

13 ? Assist ed Living Facilit y

3 Are t here any guidelines for Palliat ive Care program s?

Answ er: The National Coalition for Hospice and Palliative Care offers a guideline at the link here: https://www nationalcoalitionhpc org/ncp/