Pediatric Coding Alert

Question: Are 99324-99337 and 99339-99340 for home care?

Montana Subscriber

Answer: You can use the latter code set (99339-99340, Individual physician supervision of a patient [patient not present] in home, domiciliary or rest home ... requiring complex and multidisciplinary modalities ... within a calendar month ...) for care plan oversight (CPO) of home care.
 
The first set of codes (99324-99337, Domiciliary or rest home visit for the evaluation and management of a ... patient) is for face-to-face services the physician provides to domiciliary, rest home or custodial care patients.
 
A pediatric practice is more likely to use the second set of codes. Codes 99339-99340 describe the work a physician provides for CPO on a monthly basis while performing frequent complex supervision services to a patient in a home, domiciliary or rest home. (For more details on these codes, see the January 2006 Pediatric Coding Alert's "You Be the Coder: Learn Home CPO Service Criteria.")
 
Unlike 99339-99340, which describe monthly services, 99324-99337 represent per-day face-to-face E/M services. You should use 99324-99337 with place-of-service 33 (Custodial care facility), which describes a facility that provides room, board and other personal assistance services, generally on a long-term basis. Such facilities do not have a medical component, which distinguishes them from a nursing facility (POS 32).
 
Private residence doesn't count as a facility: When a pediatrician provides E/M services to a patient in his own private residence (POS 12, Home) and not any type of facility, you should instead 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.