Evaluation and Management (E/M) Documentation Changes: Important Clarification for House Call Providers

With many changes coming out recently from CMS, providers and practices can find it difficult to keep track. So, HCCI is providing the following clarifications about one set of changes that has been creating significant confusion among house call providers.

• The new CMS 2021 documentation guidelines for the office Place of Service (POS) allow Evaluation and Management (E/M) services to be billed on time alone or on medical decision making (MDM). Please note these new guidelines apply only to the office visit code set (specifically, CPT 99201-99215).

• Providers are required to continue using the same E/M documentation and coding guidelines as in previous years (either 1995 or 1997 guidelines) when they bill the following  (Failure to do so may result in audits and/or penalties):

• • Home visits (CPT 99341-99350)
  • Domiciliary visits (CPT 99324-99337)
  • Skilled nursing facility visits (CPT 99304-99318)

HCCI continues to be an advocate for documentation burden relief and improved reimbursement for providers caring for patients in home and/or domiciliary settings, and we are hopeful the changes introduced this year for office visits will be applied to other settings in the future.

If you have questions about the recent changes in E/M documentation, please contact the HCCIntelligence™ Hotline at 630-283-9222 or email Help@HCCInsitute.org. You are also encouraged to check out the HCCI E/M Reference Guide.