“In the summer of 2021, when the delta variant was near its peak, I attempted a house call visit to review laboratory results and discuss treatment options. The family of the elderly patient did not want anyone in the house and recommended leaving the results and instructions at the front door. Lab results, my interpretation of the results, prescription and instructions were left at the front door as instructed. This, of course, required driving to the patient’s residence to accomplish this. How could this scenario be billed to Medicare?”
Let’s take a look at the rules first and foremost:
Effective January 1, 2019, for services provided in the patient’s home, Medicare does not require that the patient be “Homebound”, nor do there need to be extenuating circumstances to necessitate the home visit. Medicare will pay for home services based on medical necessity. Based on the Medicare Carriers Manual, Section 15515, Medicare will pay for home service codes CPT 99341-99350 when they are billed to report an E/M service provided in the home. THE PHYSICIAN HAS TO ACTUALLY BE PRESENT IN THE HOME OF THE BENEFICIARY. It is not necessary that the patient be confined to the home. A patient’s home may be his/her own dwelling, an apartment, a relative’s home, a home for the aged, a retirement community, a senior citizen facility, or another type of senior living accommodation. Based upon (MCM Section 2051.1 ) Homebound Criteria is no longer a requirement for a house call to be performed.
So, the physician has to actually be present in the home of the patient. I am sorry that the physician had to drive to the home of the patient. I am sorry the house call visit could not be made in the patient’s home to review laboratory results and discuss treatment options. I am sorry that the patient’s family did not want anyone from outside the house let into the house and wanted the results and instructions left at the front door. I am sorry. This does not qualify as a service provided in the home qualifying for an E/M service and cannot be billed as such.
I have two questions:
Question 1: Wouldn’t it have been practical to call the patient prior to the scheduled home visit to confirm that the home visit was going to proceed as planned at the designated time?
Question 2: If the patient’s family was not going to let the physician enter the home to have a face to face encounter with the patient, why not arrange to have a virtual visit such as:
Medicare Telehealth Visit
Virtual Check-In
E-Visit
Telephone Service
I am not being critical. I am only making suggestions so that time is not wasted and the physician is reimbursed for providing the needed service.
This is my opinion.
Michael G. Warshaw
DPM, CPC
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