rleif1sun
Guru
is there a specific E/M code for when providers sees established elderly patient at patient's home to perform well exam? or do i just code 99397 with POS 12?
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Wiki home well visit
- Thread starter rleif1sun
- Start date
jeffreycarlisle
New
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Does anyone have an answer for this? I am running into the same situation, the payer is Medicare.
Last edited:
TThivierge
True Blue
Hi Jeff and Rleif, 
Try CPT 99341 99342 99344 99345 home services. They deleted CPT 99343 for home services. The other valid CPT 99347 & 99350 for home or residence services. Document by provider or QHP while ensure document MDM, History & exam, complaint, new or est. pt in differ type of home locations. Provider must document at least 15 minutes in order to bill home services. Travel time not included in documentation and can report chronic care CPT 99491 if warranted. You can use differ modifiers 25, 24, 57 if warranted too. If home visit longer than 90 minutes can add prolonged CPT code CPT 99417. Check pg 26 in CPT manual year 2023. Also probably might use last dx codes Z74.04 or Z99. Also we use dx R53, M62.81, R54, I69, J44, or Cancer illness if apply. Always check with your payer in coverage guide and if more credentialing data on providers required.
I hope I helped you.
Lady T
Try CPT 99341 99342 99344 99345 home services. They deleted CPT 99343 for home services. The other valid CPT 99347 & 99350 for home or residence services. Document by provider or QHP while ensure document MDM, History & exam, complaint, new or est. pt in differ type of home locations. Provider must document at least 15 minutes in order to bill home services. Travel time not included in documentation and can report chronic care CPT 99491 if warranted. You can use differ modifiers 25, 24, 57 if warranted too. If home visit longer than 90 minutes can add prolonged CPT code CPT 99417. Check pg 26 in CPT manual year 2023. Also probably might use last dx codes Z74.04 or Z99. Also we use dx R53, M62.81, R54, I69, J44, or Cancer illness if apply. Always check with your payer in coverage guide and if more credentialing data on providers required.
I hope I helped you.
Lady T
Last edited:
jkyles
True Blue
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Hi there. Medicare doesn't cover 99397 at all. The Medicare annual wellness visit (G0438-G0439) must be performed in the physician's office, inpatient or outpatient hospital, skilled nursing facility, critical access hospital or federally qualified health center. However, the Medicare telehealth waivers would allow a provider to perform an AWV via telehealth for a patient who is at home.