Wiki Home visits performed via telehealth

[Queizati]

Hi all,

Is anyone able to clear up some confusion with the home visit CPTs 99341-99350.

I just came across a few claims where my provider is billing CPT 99350 when performing a telehealth visit from the office via video and the patient is in their home at the time of service.

At first, I thought the physician simply took a very flexible interpretation of the code descriptor reading as 'Home or residence visit'.

However, when I checked CMS' allowable CPT codes for telehealth, these codes are on there. How is it possible that a home visit can be provided via telehealth and still be a home visit? Am I missing something here?

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[jkyles]

Hi there, I'm not sure I understand the issue.

If the provider would have performed the in-person patient visit at the patient's home, you would report telehealth visits with the home E/M codes. However, if the telehealth visit is being performed in place of a face-to-face office visit you can stick with the office E/M codes.

 

[Queizati]

Hi there, I'm not sure I understand the issue.

If the provider would have performed the in-person patient visit at the patient's home, you would report telehealth visits with the home E/M codes. However, if the telehealth visit is being performed in place of a face-to-face office visit you can stick with the office E/M codes.

I see, so it's about the intent of the visit then. My confusion came about as what set apart the home visit CPTs from the other E/M services was that it required that the billing provider be present in the patient's home for the visit. Because that criterion is not being met due to the virtual nature of the visit, I wondered then if the service would just be billed as an office E&M (e.g 99214) since the provider is in the office at the time of service and the patient in their home.

 

[jkyles]

Right, the telehealth version of any E/M visit will never meet all of the criteria for the "normal" version. The intent is a better way to think about it, but you should of course always ask the provider what's up.