CPT coding for hospice in long-term care.

The ability to correctly code and document for purposes of physician reimbursement has become an increasingly essential part of long-term care (LTC) practice. As was pointed out by Stone and Tarnove in a recent article, “the complexity and nuances of these codes have cost physicians huge sums of money and actually have driven many excellent, caring physicians to stop providing services to our nation’s frail older residents.” As a result, that same article proceeded to explain the sometimes-circuitous pathway through this coding maze. The actual billing codes that are most often used are outlined in that article and are not duplicated here. However, that article made only brief mention of the even more complicated billing rules for services provided for the LTC patient who is on hospice. This article is an attempt to shed light on this nebulous area of hospice-related reimbursement. First, an overview of hospice insurance benefits is presented followed by specific situations depending on the patient’s and/or provider’s status. Finally, some additional suggestions and hints are provided.