Documentation Required to Support Home Visits
If your practice is being denied payment for evaluation and management (E/M) services provided to established patients in their homes, there could be a logical explanation.
The Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, chapter 12, section 126.96.36.199.B states:
Home services codes 99341-99350 are paid when they are billed to report evaluation and management services provided in a private residence. A home visit cannot be billed by a physician unless the physician was actually present in the beneficiary’s home.
When billing for a home visit for the E/M of an established patient, it is also essential for the provider to include information in the medical record that supports the necessity of the home visit.
Per section 188.8.131.52.B:
The medical record must document the medical necessity of the home visit made in lieu of an office or outpatient visit.
Medicare administrative contractor National Government Services explains further:
Home visits are not covered when provided simply for the convenience of the patient. … For example, an elderly, frail patient may not be able to travel to a physician office in February with ice and snow on the ground and below freezing temperatures, but may easily do so in May or June. Patients who are able to go to offices/hospitals for tests or elsewhere for recreational activities might be expected to do the same for their physician visits.
If the necessity of the home visits is not clearly indicated, these visits will be re-coded to the Office or Other Outpatient Services Established Evaluation and Management Service code (CPT 99211-99215) at a level supported by the documentation.