Question

Case 13.3 Using Insurance Terms

Read this information from a Medicare carrier and answer the questions that follow.

E&M services rendered in a private residence are correctly billed with CPT codes 99341–99345 (new patients) and CPT codes 99347–99350 (established patients), home services. These CPT codes are payable only in home settings, that is, place of service 12. National Government Services has seen many instances of providers billing outpatient/office codes in home set¬tings. Home visits should not be reported with E&M codes 99201–99215, which represent office and outpatient services.

A. LO 13.3 Based on Table 13.2, what claim adjustment reason code will result if this code is billed 99201, POS 12?

B. LO 13.3 Which Remark Code would appear, N210 or N211?

Answer 1

Home visits are those when physician directly provide evaluation and management(E/M) visits in a beneficiary's home.This is to improve medical care in a home environment. In this service, provider must be present and provide face to face services. Home service visits with CPT Codes 99341-99350 may be billed when services are provided in beneficiary's private residence(POS 12).

A. If the code is billed 99201, POS 12 then claim adjustment code would be No.5 "The procedure code/bill type is inconsistent with the place of service". This is because CPT code 99201 is related with billing outpatients/office codes.

B.N211- You may not appeal this decision.