HCPCS Code T2042: Hospice Routine Home Care; Per Diem

Learn about the HCPCS code T2042 for "hospice routine home care; per diem" through this short guide.

## **Hospice Routine Home Care; Per Diem HCPCS code T2042** The HCPCS code T2042 is meant to designate the provision of hospice routine home care, specifically per diem (per day). Please note this is for hospice care delivered in the patient's home/place of residence, not inpatient hospice care. When we speak of hospice care (or end-of-life care), we speak of a type of palliative care service provided to terminally ill patients who are nearing the end of their lives because they are at the end stages of whatever terminal diseases they have, such as cancer, end-stage heart failure, chronic obstructive pulmonary disease (COPD), etc. This hospice routine care is done in the patient's home and aims to manage symptoms, provide emotional support, and improve the quality of life for both the patient and their family. Hospice routine care is a compassionate type of care. It doesn't just aim to manage symptoms, provide emotional and spiritual support, etc. It's also to ensure the dignity of the patient during their final days. Services provided to patients in hospice routine home care include skilled nursing visits, home health aide services, social work support, chaplain/spiritual counseling, pain management, medications for the terminal illness, medical supplies, and durable medical equipment. This per diem HCPCS code means the bundled routine care provided on that day is covered.

## **Documentation requirements for T2042** As with any HCPCS code, you'll need sufficient documentation that satisfies your insurer's coding guidelines, requirements, related policy articles, and local coverage determinations before you file for a claim. Here are examples of what you need: - The full name of the patient, including the full names of their family members in their household - The full names and credentials of the hospice routine home care members. These include all the doctors, hospice nurses, aides, therapists (physical, occupational, speech, etc.), and more - Certification of terminal illness by a physician or nurse practitioner - Election of hospice benefit form signed by the patient or their representative - Comprehensive assessment results of the patient. The assessment must have been conducted by the hospice team - Relevant indications (e.g., severe symptoms affecting quality of life, terminal illness with a six month prognosis or less, etc.) - Plan of care set by the hospice team - Daily notes reflecting services rendered (e.g., nursing, aide visits, medications, counseling, etc.) - Location of care (it has to be the patient's home) Start and stop dates of hospice care

## **Billing requirements for T2042** Besides the documentation requirements above, please make sure to take note of or have the following: - T2042's common name: hospice routine home care; technical term: hospice routine home care, per diem - Each day of care = 1 unit of service (e.g., 10 days = 10 units) - Use the appropriate ICD codes that are appropriate for the patient's condition - Again, remember that this is for home hospice care. You cannot use this code for inpatient hospice care - Please use appropriate modifiers based on your insurer (e.g., Medicare, Medicaid, or private insurance) - Medications, supplies, and DME related to the terminal illness are included in the hospice rate and not billed separately

## **Other similar codes to Hospice Routine Home Care T2042** - **T2043** - Hospice continuous home care; per hour - **T2044** - Hospice inpatient respite care; per diem - **T2045** - Hospice general inpatient care; per diem - **T2046** - Hospice long-term care, room and board only; per diem