Pediatric Coding Alert

House Calls: Reimbursement Opportunity in New Home Services Codes


- Published on Sun, Mar 01, 1998

Ever since colonial times, when babies were born at home and sick children remained there under a physician's care, pediatricians have routinely made house calls.
Reimbursement has rarely been adequate for such services, though. Furthermore, pediatricians nowadays are just too busy. You cant be expected to see five patients in an hour if you have to travel to them. Also, it is easier to take care of most patients in your office or the hospital.

But there can be a place for house calls -- now called home visits. And the service has finally been given the imprimatur of a full range of Evaluation and Management (E/M) codes. Until this year, there were inadequate home-visit codes for higher level cases, those involving complex chronic care. However, this year several home-visit codes that were introduced five years ago have been reviewed, and made more appropriate for pediatrics. The original codes were meant for homebound elderly with chronic diseases. The 1998 codes were revised with input for realistic pediatric home health situations; in addition, new codes have been added. For complex chronic care (special-needs children), pediatricians can use these codes and their reimbursement has the potential to increase by 50 percent over the 1997 codes.

Reimbursement and Home Care

With home care until now used mainly for geriatric patients, there was little relevance for pediatricians. There used to be no way to get good reimbursement for home visits, says Allen I. Goldberg, MD, FAAP, director of pediatric home health at the Ronald McDonald Childrens Hospital at Loyola University Medical Center in Maywood, IL. There werent enough codes for pediatricians, he says.

All that has changed. Goldberg, who is also the founder of the AAPs section on home health care, says the field has opened up considerably for pediatrics. The first move occurred when a care-oversight code was added (more about that code coming in the April 1998 issue of PCA). Last year, when Medicare overhauled its home-visit codes, Goldberg was ready to make sure pediatricians voices were heard. We came up with some pediatric scenarios to utilize the codes, he explains. The scenarios were written by Goldberg with input from other members in the AAP's section on home health.

The relative values were also upgraded. And now, pediatricians can take care of a complex child with special-care needs at home and have the potential to be adequately reimbursed, says Goldberg. The home-services codes fit in with what managed care wants too: it is less expensive to provide care at the patient's home than in the hospital.
Here are the revised as well as new home-services codes, plus sample scenarios applying to their pediatric use:

99341 (revised code): New patient requiring a problem-focused history, problem-focused examination, [...]

Pediatric Coding Alert
Issue - Mar, 1998
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