Home-Based Medical Care: Evaluation and Management (E/M) Guidelines - HCCIntelligence™ Premier Resource - 2024-Evaluation and Management (E/M) Guide 2024

Evaluation and Management (E/M) Guide 2024

Pdf Summary

This document serves as a reference for home-based providers regarding the Evaluation and Management (E/M) documentation and coding guidelines for billing home visit services. The main criteria for selecting the appropriate code within the CPT range 99341-99350 are Medical Decision Making (MDM) or total time, with history and exam no longer being part of the code selection requirement. Domiciliary, rest home, or custodial care services are billed with home and residence services codes.<br /><br />It's important to note that time includes services before, during, and after the encounter, and there is no longer a requirement for 50% of the time to be spent on counseling and coordination of care. However, a medically appropriate history and exam should still be documented when performed, as the E/M revisions only clarify that the length and formatting are no longer factors in determining the code level.<br /><br />The level of decision-making is based on the number and complexity of problems addressed at the encounter, the amount and/or complexity of data to be reviewed and analyzed, and the risk of complications and/or morbidity or mortality of patient management.<br /><br />Contrary to common misconception, patients do not need to meet Medicare's definition of "homebound" to receive a house call. The CMS Claims Procession Manual states that for home services provided using CPT codes 99341-99350, the beneficiary does not need to be confined to the home.<br /><br />The document includes a grid with the different code levels, typical time ranges, and the criteria for each level based on the number and complexity of problems, amount and/or complexity of data, and risk of complications and/or morbidity or mortality.<br /><br />In addition to the guidelines, the Home Centered Care Institute offers resources such as webinars, tools, tip sheets, and a hotline for home-based primary care providers and practice staff.<br /><br />It's important to note that this document is for individual use only and should not be copied, altered, or distributed. The information provided is accurate at the time of publication and is subject to change.

Keywords

home-based providers

E/M documentation

coding guidelines

CPT range 99341-99350

Medical Decision Making

domiciliary care

home and residence services codes

medically appropriate history

decision-making level

CMS Claims Processing Manual