HCCIntelligence™ Premier Webinar: Mastering E/M Coding & Documentation-E_M Guide for Home Visits

E_M Guide for Home Visits_HCCI

Pdf Summary

The document from the Home Centered Care Institute provides comprehensive guidelines for billing and coding for home visits and visits to assisted living facilities (DOM visits). It outlines procedures for both new and established patients, detailing the requirements for different levels of service.<br /><br />### New Patient Home and DOM Visits:<br />- **CPT Codes 99341 to 99345 (Home) and 99324 to 99328 (DOM)** specify five levels of service.<br />- Each level is defined by the level of history, the level of examination, and the complexity of medical decision making (MDM).<br />- Duration of visits ranges from 20 minutes (Level 1) to 75 minutes (Level 5) for home visits.<br />- Prolonged service thresholds are also provided, such as 50 minutes for Level 1 to 105 minutes for Level 5.<br />- All three components (history, exam, MDM) must be met to support the level of service, and billing based on time is allowed if over 50% of the visit was spent on counseling or coordination of care.<br /><br />### Established Patient Home and DOM Visits:<br />- **CPT Codes 99347 to 99350 (Home) and 99334 to 99337 (DOM)** define four service levels.<br />- Similar to new patient visits, these are categorized by the level of history, the level of examination, and MDM complexity.<br />- Visit durations range from 15 minutes (Level 1) to 60 minutes (Level 4).<br />- Prolonged service thresholds are lower than those for new patients.<br />- For established patients, only two out of the three components (history, exam, MDM) need to be met to support the service level.<br /><br />### Determining the Level of Medical Decision Making (MDM):<br />- The document provides a detailed scoring system to determine MDM complexity based on the number of diagnoses or treatment options, the amount and/or complexity of data reviewed, and the risk of complications or morbidity/mortality.<br />- MDM is categorized into minimal, low, moderate, and high complexity based on the cumulative score of these elements.<br /><br />### Risk Factors:<br />- The risk of complications and/or morbidity or mortality is also outlined, with specific examples of diagnostic procedures and management options corresponding to minimal, low, moderate, and high-risk levels.<br /><br />In summary, the document is a detailed resource for healthcare providers on how to properly code and bill for home and DOM visits, emphasizing the requirements for history, examination, MDM, and the appropriate use of time-based billing.

Keywords

Home visits

Assisted living facilities

CPT codes

New patients

Established patients

Medical decision making

Billing guidelines

Service levels

Prolonged service

Risk factors