Podiatry Coding & Billing Alert

Question: Our podiatrist sometimes gets requests for house calls from senior patients. The CPT manual provides codes for house calls and domiciliary care. How do I ensure that our doctor gets reimbursed?

Wisconsin Subscriber

Answer: To make sure that your doctor gets paid for home service, you will need to provide the correct code from the home visit series depending on whether the patient is new (99341-99345, Home visit for the  evaluation and management of a new patient ...) or established (99347-99350, Home visit for the evaluation and management of an established patient ...). Plus, make sure you also have documentation that shows that the home visit was medically necessary. This is particularly true for Medicare patients.

Here's why: Medicare guidelines require a written record showing that the house call was a better option for the patient than an office or outpatient visit. The records must stipulate that the patient had a medical reason  to see your doctor, such as a foot ailment or injury, and that she is unable to travel to your doctor's office due perhaps to severe pain or inability to walk without assistance.

Tip: If your patient has private insurance, check the insurer's guidelines for home visits. Request these guidelines in writing before you create your own billing procedures for such services.

-- Answers to You Be the Coder and Reader Questions were provided and/or reviewed by Richard D. Odom, DPM, CPC, a podiatrist in Spanish Fort, Ala and Arnold Beresh, DPM, CPC, of Peninsula Foot and Ankle Specialists PLC in Hampton, Va.