Wiki Do I bill Transitional Care or Home Visit?

[nini.mclean@gmail.com]

We are a Family Practice. A patient was following up from hospital discharge at the office. However, do to movement limitations patient couldn't come into the office. My provider went outside to exam patient in parking lot but it wasn't adequate care. So, he agreed to do a home visit with the patient the next day. He and the nurse were at the patient's home for approximately 1.5 hours. My question is do I bill transitional care or home visit for the patient?

 

[Cynthia Hughes]

The answer depends on whether your physician/provider met all of the requirements for transitional care management (eg, contact within 2 business days of discharge, visit within 7 or 14 days) and the extent of the visit performed in the parking lot (ie, did it involve moderate or high complexity MDM or was it impossible to provide an E/M of any significance). The first face-to-face visit is included in the transitional care management service when reporting that service. If not reporting transitional care management or the visit in the parking lot included moderate or high level medical decision-making, the home visit may be separately reported and if actual face-to-face time is documented might even meet the highest level of home visit codes and prolonged service. Be sure not to include travel time in the time of the home visit.

Your documentation and how it supports the requirements for each service provided has to be the determining factor. Since some health plan policies don't include payment for transitional care management, that might simplify the decision of what service(s) to report. Hope that helps a little.

Cindy