Podiatry Coding & Billing Alert

Remember: Always ensure your documentation is complete and legible.

If your podiatry practice struggles with knowing when to correctly report the evaluation and management (E/M) codes for home visits (99341-99350), you're not alone.

In fact, in the recent webinar "Routine Foot Care and Debridement of Nails," Judy Brown, CPC, provider outreach and education consultant at National Government Services (NGS), acknowledged the confusion many providers experience regarding home visits. This confusion has prompted the NGS medical review department to conduct pre-paymentaudits on home visits, Brown says.

Answer the following five home visit FAQs to always submit clean claims for these services.

FAQ 1: What place of service (POS) should you bill for home visits?

Answer: You should only report POS 12 (Home) for home visits.

You should only use home visit codes to report E/M services a podiatrist furnishes to a patient who resides in his own private residence, such as a private home, an apartment, or a townhome, Brown says.

This does not include patients who reside in any type of facility living arrangement like an assisted living facility or group home, Brown adds.

One of the biggest mistakes people make regarding home visits is billing the incorrect POS, Brown says. Check out this example: A podiatrist provides an E/M service to the patient in the office, but he bills the service with home visit POS 12 instead of the correct POS for an office visit - POS 11 (Office).

Another common mistake people make is reporting POS 16 (Temporary lodging). The 2017 CPT® manual defines POS 16 as "a short-term accommodation such as a hotel, campground, hostel, cruise ship, or resort where the patient receives care." You should never report POS 16 for home visits.

Takeaway: Make sure when you're billing home visit services they are actually taking place in the patient's home and that you're reporting POS 12, Brown advises.

FAQ 2: What E/M codes should you report for home visits?

Answer: CPT^® gives you nine choices for E/M home visit codes.

You'll report home visits for new patients with the following five codes. The podiatrist must provide all three of the listed key components:

• 99341 (... a problem focused history; a problem focused examination; and straightforward medical decision making ...)
• 99342 (... an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity ...)
• 99343 (... a detailed history; a detailed examination; and medical decision making of moderate complexity ...)
• 99344 (... a comprehensive history; a compre­hensive examination; and medical decision making of moderate complexity ...)
• 99345 (... a comprehensive history; a comprehensive examination; and medical decision making of high complexity ...).

You'll report the following four home visit codes for established patients. The podiatrist must perform at least two of the three listed key components:

• 99347 (... a problem focused interval history; a problem focused examination; straightforward medical decision making ...)
• 99348 (... an expanded problem focused interval history; an expanded problem focused examination; medical decision making of low complexity ...)
• 99349 (... a detailed interval history; a detailed examination; medical decision making of moderate complexity ...)
• 99350 (... a comprehensive interval history; a comprehensive examination; medical decision making of moderate to high complexity ...).

FAQ 3: What does medical necessity have to do with home visits?

Answer: CMS emphasizes the importance of medical necessity when it calls it "the overarching criterion for payment in addition to the individual requirements of a CPT^®  code."

"Medical necessity is the over-arching criteria for all services - not just E/M services," adds Suzan Hauptman, MPM, CPC, CEMC, CEDC, AAPC Fellow, senior principal of ACE Med Group in Pittsburgh.

Medical necessity is the basis of Medicare coverage for all providers, regardless of what type of provider you are, Brown adds.

Tip: "It's not the amount of the medical documentation you submit, but the specificity of what you're sending us," Brown says. "It's good practice to document a service with a patient as soon as it was performed thereafter because that's when it's freshest in your mind.

FAQ 4: Why is it vital to ensure the medical documentation is complete and legible?

Answer: If the reviewer cannot read the medical documentation, you'll receive a medical necessity denial because it's either illegible or incomplete, according to Brown.

"Keep in mind that someone who does not know your office is reviewing your medical records," Brown adds. "They have to be able to paint a very clear picture of the patient just from what they are reading."

Incomplete or illegible documentation may also lead to liability issues, says Machelle Morningstar, CPC, COC, CEMC, COSC, AHIMA-approved ICD-10-CM/PCS trainer and owner/consultant at Morningstar Coding and Reimbursement Consultants in Charleston, South Carolina.

"These liability issues may include the wrong medication given, another physician or healthcare professional providing the wrong treatment, and coding and billing errors due to lack of correct documentation," Morningstar says.

When you use a consistent format for your medical documentation, such as a SOAP note, you stand a higher chance of including all of the required elements you need for coding and billing, Morningstar adds.

Try this: To sustain legible documentation, always review the medical record before it goes out the door, says Marcella Bucknam, CPC, CCS-P, COC, CCS, CPC-P, CPC-I, CCC, COBGC, manager of clinical compliance with PeaceHealth in Vancouver, Washington. Double-check that all relevant referrals, test results, or any other information that needs to be included in the documentation is there.

Bonus tip: If you use acronyms in your office, send an acronym key to your payer that describes what the acronyms mean so the reviewer can cross-reference it, Brown says. You can also send in a cover letter or anything else that makes the record clearer for the reviewer.

FAQ 5: Why should you double-check the services you are billing?

Answer: You should always double-check which services you bill because billing for a home visit instead of the actual service the podiatrist performed (like routine foot care or debridement of nails) is a common error that some practices make.

"You are supposed to be billing for the services you are actually rendering," Brown says. "So, if it's routine foot care or nail debridement, make sure that's what you are billing for and not an E/M service."