If Hospice Chaplains could bill like physicians...

I got to visiting with our parish's Priest Associate via e-mail today, and we sort of got on the subject of "coding and billing," being as how her "paying job" is the local Hospice chaplain. Evidently Medicare pays a flat rate ($120.00, it appears) for "per diem" Hospice service. We got to talking about how it's too bad she doesn't get to bill like physicians. So in the spirit of a post I did a while back on "Eucharistic Coding and Billing," here's how I'd break up Hospice chaplain billing for Medicare!

Hospice Chaplain Coding and Billing
(by Kirkepiscatoid)

Here's how we could build in "Level of Service" if only the government would take the cue that hospice chaplains should get to bill more like physicians!

Hospice Chaplain Level of Service Billing

Instructions: For each patient encounter, choose the level of pastoral service, geographic modifier, and clinical demographic modifier that best represents the normal and customary level of service provided in the patient encounter. Remember: For proper reimbursement, level of service must be documented in hospice chaplain notes.

Pastoral Service codes:

_____P66601: Talked with patient but did not pray with patient
_____P66602: Prayed with patient (e.g., comatose, unresponsive) but did not talk with patient
_____P66603: Talked and prayed with patient
_____P66604: Provided Eucharistic services with liquid substance other than wine with at least 10% alcohol content
_____P66605: Provided Eucharistic services with wine containing at least 10% alcohol content
_____P66606: Patient died before arrival of chaplain; discussions/prayer with family
_____P66607: Funeral planning with input from not-quite-dead-yet patient
_____P66608: Funeral planning with patient already dead
_____PS6600: Level of pastoral service not otherwise specified (provide documentation)

Geographic Modifier Codes:

_____GPS001: Usual and customary ability to find patient's house
_____GPS002: Difficulty finding patient's house (e.g., faulty directions, missing road signs/street signs, very remote location)
_____GPS003: Got hopelessly lost finding patient's house, requiring use of cell phone
_____GPS004: Got hopelessly lost finding patient's house, requiring use of cell phone, in "dead cell phone" area
_____GPS005: Visit required extraordinary vehicular measures (e.g., studded snow tires, four wheel drive)
_____GPS006: Chaplain got stuck en route to visit
_____GPS000: Other geographic modifier not otherwise specified (provide documentation)

(NOTE: A 10% PENALTY exists on GPS code billing if chaplain is female and visit requires being chauffeured by a male. A 10% BONUS exists if chaplain is male and visit requires being chauffeured by a female, as most male chaplains would not admit this.)

Clinical Demographic Modifiers:

_____CH23001: Pastoral services provided to under 4 total family members in room, in addition to patient
_____CH23002: Pastoral services provided to 4 or more family members in room, in addition to patient
_____CH23003: Patient divulges deep dark family secret under the influence of narcotics during visit
_____CH23004: Chaplain breaks up verbal altercation between relatives
_____CH23005: Chaplain breaks up physical altercation between relatives
_____CH23006: Living arrangements for patient has worse than usual smells or sights associated with typical dying patient or typical home
_____CH23007: Family member "hits on" chaplain, desiring inappropriate psychological, financial, or physical relationship
_____CH23008: Chaplain visit occurs while patient, spouse/significant other and object of covert romantic relationship are all in the same room
_____CH23000: Other clinical history modifier not otherwise specified (provide documentation)