Internal Medicine Coding Alert

Question: Our doctor went to a patient's home for a home visit and found the patient dead. He did a brief physical exam to make the official determination. There is no charge for "pronouncement of death" that I am aware of, but can a regular home visit be charged because he probably took a brief history from a family member and did an exam?

Texas Subscriber

Answer: You are correct that there is no code for the "pronouncement of death." The physician, however, is still providing a service and may bill for it, just as the physician bills for a discharge when the patient dies in the hospital.

Because the patient was dead when the physician arrived, the service provided probably won't meet the requirements for using the home services codes (99341-99350). For a new patient, the physician service must include the three key components (history, exam and medical decision-making). If the patient was established in the practice, you would need two of the three key components to use the home services codes.

The physician likely did not take a history or use medical decision-making of sufficient complexity to meet the code requirements in the scenario described. So your best choice is to code the visit using 99499 (Unlisted evaluation and management service). When using 99499, you must file a paper claim, include a cover letter explaining the service provided and attach the medical record to the claim.