Practice Management Alert

Question: Our doctor made a house call, so our claim will go with code 99347 and POS 12. I have to set up our IDX location with a hard-coded address. The question is, what address is appropriate -- our normal office address or the patient's address?


Connecticut Subscriber


Answer: You should leave that field blank. The home address is already on the claim, so you don't have to repeat it. You should never use the address on a POS 12 (Home) claim.

Noridian, which is a Medicare carrier that covers the Western United States, explains this on in its CMS-1500 Claim Form Instructions in these words about Item 32 on the CMS-1500 form:

-Enter the name, address, and zip code of the facility if the services were furnished in a hospital, clinic, laboratory, or facility other than the patient's home or physician's office. Effective for claims received on or after April 1, 2004, ... the name, address, and zip code of the service location are needed for all services other than those furnished in place of service home -- 12.-

CPT guidance: Private residences don't count as a facility. When a physician provides E/M services to a patient in his own private residence and you report POS 12 and not any type of facility on the claim, you should use the home service codes 99341-99350 (Home visit for the evaluation and management ...), according to CMS rules. So even if a patient is -at home- in the domiciliary or rest home, you would not use 99341-99350.