Home Visits


Best answers
I need help! I have a physician who does home visits. Medicare is auditing all of his notes and denying them for "not medically necessary" . If Medicare deems a person was not homebound, can we change the code to an office visit code with POS 12?


True Blue
Local Chapter Officer
Modesto, CA
Best answers
There are specific CPT codes for Home Visits by a physicians for E&M. 99341-99345 for a new patient and 99347-99350 for established patient and POS would be appropriate with these codes. However the medical necessity of the home visits is at the discretion of Medicare and can trigger an audit. For example see the from Part B News in 2016:

In the latest Work Plan, the OIG noted that Medicare has paid almost $560 million for home visits since January 2013. It intends to audit claims to determine whether physician documentation supports the medical necessity of a home visit or whether the patient should have received a less costly office visit. The services have already received national and Medicare administrative contractor (MAC) scrutiny, so don’t expect any leniency if your claims don’t stand up to OIG’s audit.

National Government Services doesn’t have an LCD, but it has conducted a pre-payment review of certain home visits. In its report, it reminded providers that patients don’t have to be homebound to receive visits but, as with all Medicare services, the visit can’t be performed solely for patient convenience. In addition, circumstances may make home visits necessary at some times and unnecessary at others. NGS gave the example of a frail patient who can’t go to the doctor’s office when the weather is cold and the ground is icy but is able to do so when the weather is mild. The documentation for each visit should show why it is necessary, and watch out for cloned notes. If the reason is the patient can’t travel in winter, but the visit took place in July, that would indicate a medically unnecessary visit.