Re: parking lot visit: 2nd office or home(car) visit?

[Guest guest]

Good job.  Haven’t a clue on how to code it though.  You

could get very creative.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From:

[mailto: ] On Behalf Of stewmones

Sent: Wednesday, January 06, 2010 8:07 AM

To:

Subject: parking lot visit: 2nd office or

home(car) visit?

Made an unusual visit yesterday and wonder how to

bill (or if I can)

Family called to say my 75 yo patient was hallucinating and had been harassing

the local police department and 911 all week - not taking her meds (synthroid

and depakote)and when she heard I was coming to make a home visit . . . she bolted.

I visited her at the Fred Meyer parking lot where she was refusing to leave her

car after 5 hours in a " mexican standoff " (her words). The family

took her keys. The police had already come and gone " without cause "

to take her to the ED.

I did a mental health eval at the side of her car - delirium. Noticed she was

incontinent of urine and anemic - probable UTI and hypothyroid, and counseled

the family for 20 minutes (while face to face with the patient although a bit

out of earshot).

We came up with a plan, and the upshot was that after a 12 hour " mexican

standoff " she ended up in the ED diagnosed with a UTI, TSH of 15, and put

on a 2 physician hold. whew!

Was this a home visit or an office visit? or is there a code for parking lot

visit? How many hours do you have to be in your car before it is considered

your home? Does it matter that I never got in her car (home) with her?

Stew

[Guest guest]

Stew, I wouldn't think twice about billing it as a home visit. Just document

that that was the original intent and why it evolved into a parking lot visit.

Certainly it was much more difficult and, I imagine, time-consuming than a

" traditional " home visit!---Sharlene---

>

> Made an unusual visit yesterday and wonder how to bill (or if I can)

> Family called to say my 75 yo patient was hallucinating and had been harassing

the local police department and 911 all week - not taking her meds (synthroid

and depakote)and when she heard I was coming to make a home visit . . . she

bolted.

> I visited her at the Fred Meyer parking lot where she was refusing to leave

her car after 5 hours in a " mexican standoff " (her words). The family took her

keys. The police had already come and gone " without cause " to take her to the

ED.

> I did a mental health eval at the side of her car - delirium. Noticed she was

incontinent of urine and anemic - probable UTI and hypothyroid, and counseled

the family for 20 minutes (while face to face with the patient although a bit

out of earshot).

> We came up with a plan, and the upshot was that after a 12 hour " mexican

standoff " she ended up in the ED diagnosed with a UTI, TSH of 15, and put on a 2

physician hold. whew!

> Was this a home visit or an office visit? or is there a code for parking lot

visit? How many hours do you have to be in your car before it is considered your

home? Does it matter that I never got in her car (home) with her?

> Stew

>

[Guest guest]

I agree, home visit code.

Good job taking such excellent care of someone who needed it.

Sharon

 

Stew, I wouldn't think twice about billing it as a home visit. Just document that that was the original intent and why it evolved into a parking lot visit. Certainly it was much more difficult and, I imagine, time-consuming than a " traditional " home visit!---Sharlene--- >> Made an unusual visit yesterday and wonder how to bill (or if I can)

> Family called to say my 75 yo patient was hallucinating and had been harassing the local police department and 911 all week - not taking her meds (synthroid and depakote)and when she heard I was coming to make a home visit . . . she bolted.

> I visited her at the Fred Meyer parking lot where she was refusing to leave her car after 5 hours in a " mexican standoff " (her words). The family took her keys. The police had already come and gone " without cause " to take her to the ED.

> I did a mental health eval at the side of her car - delirium. Noticed she was incontinent of urine and anemic - probable UTI and hypothyroid, and counseled the family for 20 minutes (while face to face with the patient although a bit out of earshot).

> We came up with a plan, and the upshot was that after a 12 hour " mexican standoff " she ended up in the ED diagnosed with a UTI, TSH of 15, and put on a 2 physician hold. whew!> Was this a home visit or an office visit? or is there a code for parking lot visit? How many hours do you have to be in your car before it is considered your home? Does it matter that I never got in her car (home) with her?

> Stew>

-- Sharon McCoy MDRenaissance Family Medicinewww.SharonMD.com

[Guest guest]

CAUTION: there is some extra registration step with Medicare

required before you can get paid for doing home visits. I found

that out after finally getting registered and being paid on office

visits, but I wasn't getting paid for home visits I made. I think it

was another form to fill out. I will check with office manager/sister-in-law

today and report back later.

> > >

> > > Made an unusual visit yesterday and wonder how to bill (or if I can)

> > > Family called to say my 75 yo patient was hallucinating and had been

> > harassing the local police department and 911 all week - not taking her meds

> > (synthroid and depakote)and when she heard I was coming to make a home visit

> > . . . she bolted.

> > > I visited her at the Fred Meyer parking lot where she was refusing to

> > leave her car after 5 hours in a " mexican standoff " (her words). The family

> > took her keys. The police had already come and gone " without cause " to take

> > her to the ED.

> > > I did a mental health eval at the side of her car - delirium. Noticed she

> > was incontinent of urine and anemic - probable UTI and hypothyroid, and

> > counseled the family for 20 minutes (while face to face with the patient

> > although a bit out of earshot).

> > > We came up with a plan, and the upshot was that after a 12 hour " mexican

> > standoff " she ended up in the ED diagnosed with a UTI, TSH of 15, and put on

> > a 2 physician hold. whew!

> > > Was this a home visit or an office visit? or is there a code for parking

> > lot visit? How many hours do you have to be in your car before it is

> > considered your home? Does it matter that I never got in her car (home) with

> > her?

> > > Stew

> > >

> >

> >

> >

>

>

>

> --

> Sharon McCoy MD

>

> Renaissance Family Medicine

> www.SharonMD.com

>

[Guest guest]

..... don't bill it as a consult. " That's all I have to say about that. " Craig

>

> >

> >

> > Made an unusual visit yesterday and wonder how to bill (or if I can)

> > Family called to say my 75 yo patient was hallucinating and had been

> > harassing the local police department and 911 all week - not taking her meds

> > (synthroid and depakote)and when she heard I was coming to make a home visit

> > . . . she bolted.

> > I visited her at the Fred Meyer parking lot where she was refusing to leave

> > her car after 5 hours in a " mexican standoff " (her words). The family took

> > her keys. The police had already come and gone " without cause " to take her

> > to the ED.

> > I did a mental health eval at the side of her car - delirium. Noticed she

> > was incontinent of urine and anemic - probable UTI and hypothyroid, and

> > counseled the family for 20 minutes (while face to face with the patient

> > although a bit out of earshot).

> > We came up with a plan, and the upshot was that after a 12 hour " mexican

> > standoff " she ended up in the ED diagnosed with a UTI, TSH of 15, and put on

> > a 2 physician hold. whew!

> > Was this a home visit or an office visit? or is there a code for parking

> > lot visit? How many hours do you have to be in your car before it is

> > considered your home? Does it matter that I never got in her car (home) with

> > her?

> > Stew

> >

> >

> >

>

>

>

> --

> PATIENTS,please remember email may not be entirely secure and that Email is

> part of the medical record and is placed into the chart ( be careful what

> you say!)

> Email is best used for appointment making and brief questions

> Email replies can be expected within 24 hours-Please CALL if the matter is

> more urgent .

>

>

> MD

>

>

> ph fax

> impcenter.org

>

[Guest guest]

Stew,

Bless you.  How about 16 – Temporary

lodging or 99-Other place of service?  But “check with Medicare for

reimbursement policies regarding these codes.”  If Steve did a visit like

that, I’d probably code it as an office visit.  Unless the family/patient

is going to fight the billing for the visit, you won’t raise any red

flags just using your regular office visit code.  Sounds like a visit Steve

would have done in Grants Pass…

Pratt

Office Manager

Oak Tree Internal Medicine P.C

www.prattmd.info

From: [mailto: ] On Behalf Of stewmones

Sent: Wednesday, January 06, 2010

5:07 AM

To:

Subject:

parking lot visit: 2nd office or home(car) visit?

Made an unusual visit yesterday and wonder how to bill

(or if I can)

Family called to say my 75 yo patient was hallucinating and had been harassing

the local police department and 911 all week - not taking her meds (synthroid

and depakote)and when she heard I was coming to make a home visit . . . she

bolted.

I visited her at the Fred Meyer parking lot where she was refusing to leave her

car after 5 hours in a " mexican standoff " (her words). The family

took her keys. The police had already come and gone " without cause "

to take her to the ED.

I did a mental health eval at the side of her car - delirium. Noticed she was

incontinent of urine and anemic - probable UTI and hypothyroid, and counseled

the family for 20 minutes (while face to face with the patient although a bit

out of earshot).

We came up with a plan, and the upshot was that after a 12 hour " mexican

standoff " she ended up in the ED diagnosed with a UTI, TSH of 15, and put

on a 2 physician hold. whew!

Was this a home visit or an office visit? or is there a code for parking lot

visit? How many hours do you have to be in your car before it is considered

your home? Does it matter that I never got in her car (home) with her?

Stew

[Guest guest]

, On the CMS 8551, which is the main provider application, Section 4D asks

if you are planning to do home visits, and, if so, where (you can put in an

entire state, which is what I did). I didn't have to do any paperwork beyond

that. Maybe your original application didn't indicate that you were going to do

home visits, or maybe your carrier has its own special requirements, just to add

some fun and excitement to your life!! Sharlene---

> > > >

> > > > Made an unusual visit yesterday and wonder how to bill (or if I can)

> > > > Family called to say my 75 yo patient was hallucinating and had been

> > > harassing the local police department and 911 all week - not taking her

meds

> > > (synthroid and depakote)and when she heard I was coming to make a home

visit

> > > . . . she bolted.

> > > > I visited her at the Fred Meyer parking lot where she was refusing to

> > > leave her car after 5 hours in a " mexican standoff " (her words). The

family

> > > took her keys. The police had already come and gone " without cause " to

take

> > > her to the ED.

> > > > I did a mental health eval at the side of her car - delirium. Noticed

she

> > > was incontinent of urine and anemic - probable UTI and hypothyroid, and

> > > counseled the family for 20 minutes (while face to face with the patient

> > > although a bit out of earshot).

> > > > We came up with a plan, and the upshot was that after a 12 hour " mexican

> > > standoff " she ended up in the ED diagnosed with a UTI, TSH of 15, and put

on

> > > a 2 physician hold. whew!

> > > > Was this a home visit or an office visit? or is there a code for parking

> > > lot visit? How many hours do you have to be in your car before it is

> > > considered your home? Does it matter that I never got in her car (home)

with

> > > her?

> > > > Stew

> > > >

> > >

> > >

> > >

> >

> >

> >

> > --

> > Sharon McCoy MD

> >

> > Renaissance Family Medicine

> > www.SharonMD.com

> >

>

[Guest guest]

I checked with my sister in law, and she thinks my former group

had not probably not checked off the box for home visits. I remember

I was not getting paid for them when I started doing my own billing.

But I started doing my own claims for a while before I left the old group as I

was learning how to do billing, so maybe that's what I'm remembering. Anyway,

watch out for that check box about the home visits when you fill out the

Medicare

enrollment forms!

> > > > >

> > > > > Made an unusual visit yesterday and wonder how to bill (or if I can)

> > > > > Family called to say my 75 yo patient was hallucinating and had been

> > > > harassing the local police department and 911 all week - not taking her

meds

> > > > (synthroid and depakote)and when she heard I was coming to make a home

visit

> > > > . . . she bolted.

> > > > > I visited her at the Fred Meyer parking lot where she was refusing to

> > > > leave her car after 5 hours in a " mexican standoff " (her words). The

family

> > > > took her keys. The police had already come and gone " without cause " to

take

> > > > her to the ED.

> > > > > I did a mental health eval at the side of her car - delirium. Noticed

she

> > > > was incontinent of urine and anemic - probable UTI and hypothyroid, and

> > > > counseled the family for 20 minutes (while face to face with the patient

> > > > although a bit out of earshot).

> > > > > We came up with a plan, and the upshot was that after a 12 hour

" mexican

> > > > standoff " she ended up in the ED diagnosed with a UTI, TSH of 15, and

put on

> > > > a 2 physician hold. whew!

> > > > > Was this a home visit or an office visit? or is there a code for

parking

> > > > lot visit? How many hours do you have to be in your car before it is

> > > > considered your home? Does it matter that I never got in her car (home)

with

> > > > her?

> > > > > Stew

> > > > >

> > > >

> > > >

> > > >

> > >

> > >

> > >

> > > --

> > > Sharon McCoy MD

> > >

> > > Renaissance Family Medicine

> > > www.SharonMD.com

> > >

> >

>

[Guest guest]

I agree Bless You for going above and beyond. I too would just put it in as a home visit so it would raise red flags.

To: Sent: Wed, January 6, 2010 3:12:32 PMSubject: RE: parking lot visit: 2nd office or home(car) visit?

Stew,

Bless you. How about 16 – Temporary lodging or 99-Other place of service? But “check with Medicare for reimbursement policies regarding these codes.†If Steve did a visit like that, I’d probably code it as an office visit. Unless the family/patient is going to fight the billing for the visit, you won’t raise any red flags just using your regular office visit code. Sounds like a visit Steve would have done in Grants Pass …

Pratt

Office Manager

Oak Tree Internal Medicine P.C

www.prattmd. info

From: Practiceimprovement 1yahoogroups (DOT) com [mailto: Practiceimprovement 1yahoogroups (DOT) com ] On Behalf Of stewmonesSent: Wednesday, January 06, 2010 5:07 AMTo: Practiceimprovement 1yahoogroups (DOT) comSubject: [Practiceimprovemen t1] parking lot visit: 2nd office or home(car) visit?

Made an unusual visit yesterday and wonder how to bill (or if I can)Family called to say my 75 yo patient was hallucinating and had been harassing the local police department and 911 all week - not taking her meds (synthroid and depakote)and when she heard I was coming to make a home visit . . . she bolted.I visited her at the Fred Meyer parking lot where she was refusing to leave her car after 5 hours in a "mexican standoff" (her words). The family took her keys. The police had already come and gone "without cause" to take her to the ED.I did a mental health eval at the side of her car - delirium. Noticed she was incontinent of urine and anemic - probable UTI and hypothyroid, and counseled the family for 20 minutes (while face to face with the patient although a bit out of earshot).We came up with a plan, and the upshot was that after a 12 hour "mexican standoff" she

ended up in the ED diagnosed with a UTI, TSH of 15, and put on a 2 physician hold. whew!Was this a home visit or an office visit? or is there a code for parking lot visit? How many hours do you have to be in your car before it is considered your home? Does it matter that I never got in her car (home) with her?Stew

[Guest guest]

Do check the whole stae when you check the box for home visits. I didn't and it's causing me grief and losing me some big bucks while I "reapply" for the additinal areas.

To: Sent: Wed, January 6, 2010 11:49:05 AMSubject: RE: Re: parking lot visit: 2nd office or home(car) visit?

I have done home visits since 2000 when I left residency. I have never had to fill out something special to get paid for home visit for Medicare patients. Provided the correct home visit E & M codes were used with the home POS.

From: Practiceimprovement 1yahoogroups (DOT) com [mailto:Practiceimp rovement1@ yahoogroups. com] On Behalf Of alcald3000Sent: Wednesday, January 06, 2010 10:53 AMTo: Practiceimprovement 1yahoogroups (DOT) comSubject: [Practiceimprovemen t1] Re: parking lot visit: 2nd office or home(car) visit?

CAUTION: there is some extra registration step with Medicarerequired before you can get paid for doing home visits. I foundthat out after finally getting registered and being paid on officevisits, but I wasn't getting paid for home visits I made. I think itwas another form to fill out. I will check with office manager/sister- in-law today and report back later.> > >> > > Made an unusual visit yesterday and wonder how to bill (or if I can)> > > Family called to say my 75 yo patient was hallucinating and had been> > harassing the local police department and 911 all week - not taking her meds> > (synthroid and depakote)and when she heard I was coming to make a home visit> > . . .

she bolted.> > > I visited her at the Fred Meyer parking lot where she was refusing to> > leave her car after 5 hours in a "mexican standoff" (her words). The family> > took her keys. The police had already come and gone "without cause" to take> > her to the ED.> > > I did a mental health eval at the side of her car - delirium. Noticed she> > was incontinent of urine and anemic - probable UTI and hypothyroid, and> > counseled the family for 20 minutes (while face to face with the patient> > although a bit out of earshot).> > > We came up with a plan, and the upshot was that after a 12 hour "mexican> > standoff" she ended up in the ED diagnosed with a UTI, TSH of 15, and put on> > a 2 physician hold. whew!> > > Was this a home visit or an office visit? or is there a code for parking> > lot visit? How many hours do

you have to be in your car before it is> > considered your home? Does it matter that I never got in her car (home) with> > her?> > > Stew> > >> >> > > >> > > > -- > Sharon McCoy MD> > Renaissance Family Medicine> www.SharonMD. com>

[Guest guest]

Thanks for all the positive feedback. In my previous practice I would have been

considered as crazy as my psychotic patient. The positive feedback is worth

more than the visit fee - but I'm going to bill a home visit. keep that

saw sharp - I might need it.

[Practiceimprovemen t1] Re: parking lot visit: 2nd office or home(car)

visit?

 

 

CAUTION: there is some extra registration step with Medicare

required before you can get paid for doing home visits. I found

that out after finally getting registered and being paid on office

visits, but I wasn't getting paid for home visits I made. I think it

was another form to fill out. I will check with office manager/sister- in-law

today and report back later.

> > >

> > > Made an unusual visit yesterday and wonder how to bill (or if I can)

> > > Family called to say my 75 yo patient was hallucinating and had been

> > harassing the local police department and 911 all week - not taking her meds

> > (synthroid and depakote)and when she heard I was coming to make a home visit

> > . . . she bolted.

> > > I visited her at the Fred Meyer parking lot where she was refusing to

> > leave her car after 5 hours in a " mexican standoff " (her words). The family

> > took her keys. The police had already come and gone " without cause " to take

> > her to the ED.

> > > I did a mental health eval at the side of her car - delirium. Noticed she

> > was incontinent of urine and anemic - probable UTI and hypothyroid, and

> > counseled the family for 20 minutes (while face to face with the patient

> > although a bit out of earshot).

> > > We came up with a plan, and the upshot was that after a 12 hour " mexican

> > standoff " she ended up in the ED diagnosed with a UTI, TSH of 15, and put on

> > a 2 physician hold. whew!

> > > Was this a home visit or an office visit? or is there a code for parking

> > lot visit? How many hours do you have to be in your car before it is

> > considered your home? Does it matter that I never got in her car (home) with

> > her?

> > > Stew

> > >

> >

> >

> >

>

>

>

> --

> Sharon McCoy MD

>

> Renaissance Family Medicine

> www.SharonMD. com

>

[Guest guest]

Stew! Wow. . .I'm so impressed. You've got a full-service practice.

Not sure how to bill, but want to get together for coffee sometime?

Pamela

>

> Made an unusual visit yesterday and wonder how to bill (or if I can)

> Family called to say my 75 yo patient was hallucinating and had been harassing

the local police department and 911 all week - not taking her meds (synthroid

and depakote)and when she heard I was coming to make a home visit . . . she

bolted.

> I visited her at the Fred Meyer parking lot where she was refusing to leave

her car after 5 hours in a " mexican standoff " (her words). The family took her

keys. The police had already come and gone " without cause " to take her to the

ED.

> I did a mental health eval at the side of her car - delirium. Noticed she was

incontinent of urine and anemic - probable UTI and hypothyroid, and counseled

the family for 20 minutes (while face to face with the patient although a bit

out of earshot).

> We came up with a plan, and the upshot was that after a 12 hour " mexican

standoff " she ended up in the ED diagnosed with a UTI, TSH of 15, and put on a 2

physician hold. whew!

> Was this a home visit or an office visit? or is there a code for parking lot

visit? How many hours do you have to be in your car before it is considered your

home? Does it matter that I never got in her car (home) with her?

> Stew

>

[Guest guest]

Stew,

I just remembered there are certain codes for work done inside or outside the office (like in the street or parking lot), that are "emergency" in nature or like last minute hop to it, which this certainly sounds like it was and they must be used when the interupt the normal flow of the doctor's day or the practice... So like you had a patient or two booked or perhaps even open for office hours (during your posted hours would certainly be best to support the code I believe) and then had to hop to it, go outside even your own parking lot and attend to the emerging or emergency situation for this patient. I'm having a hard time retrieving them off the top of my head, and I'm even wondering if they are in addition to the normal office based 1-5 E & M codes you would use, so probably a level 4 est patient in this case (it sounds like). So if memory servers me correct you would bill a normal E & M and then put this code on in

addition to the E & M because it is for the disruptive nature of this particular "visit" giving you back perhaps not enough, but at least something for your lost time, in attending to the pop up, emergency, outside or inside the practice visit.

And I believe there are two for inside the practice and two for outside the practice. The two main ones are for the first part of this emergency care and then the other two are for additional amounts of time spent, in case this situation got very long and out of hand. There may even be separate ones, or you can uses these same ones, if for example a patient was sick in their car and could not come in. So you go outside to see what's the matter and it turns out they maybe having an MI let's say. So you stay with the patient and keep an eye of them, monitor their vitals and the like until a Bus arrives to take them to the hospital. You can use these codes for those kinds of situations. And again I believe there are in-house ones as well to again half compensate the doc and the practice for the lost productivity to attending to a high level of need patient in an emergency situation that now is bleeding over into the rest of your day,

back you up, perhaps having to cancel (not needed though) a patient or two to stick with the high need patient and the like....

So check these out and see if they fit your needs. I just did a quick search in AC to refresh my memory.... So now here is something better than what I just wrote above... And the first two at least are above and beyond the actual E & M so I would say you should probably go with the 99060. It certainly dragged you out of the office and away from your work day and patients (I hope in terms of using the code) and you certainly were off-site and out of the office and yet not in a traditional ER or hospital, nor a house call either which there are specific codes for, so this seems like your baby... Let us know who this plays out for you...

99058 is the one for the In-Office emergency that disurpts your flow

99060 is the one of the Out of Office emergency that disurpts your flow

And here is a new one I just found too:

99288 Doc direction of EMS, Emergency Care, ALS

So perhaps that one would be useful for your situation too....

To: Sent: Fri, January 8, 2010 1:40:40 AMSubject: Re: parking lot visit: 2nd office or home(car) visit?

Stew! Wow. . .I'm so impressed. You've got a full-service practice.Not sure how to bill, but want to get together for coffee sometime?Pamela>> Made an unusual visit yesterday and wonder how to bill (or if I can)> Family called to say my 75 yo patient was hallucinating and had been harassing the local police department and 911 all week - not taking her meds (synthroid and depakote)and when she heard I was coming to make a home visit . . . she bolted.> I visited her at the Fred Meyer parking lot where she was refusing to leave her car after 5 hours in a "mexican standoff" (her words). The family took her keys. The police had already come and gone "without cause" to take her to

the ED.> I did a mental health eval at the side of her car - delirium. Noticed she was incontinent of urine and anemic - probable UTI and hypothyroid, and counseled the family for 20 minutes (while face to face with the patient although a bit out of earshot).> We came up with a plan, and the upshot was that after a 12 hour "mexican standoff" she ended up in the ED diagnosed with a UTI, TSH of 15, and put on a 2 physician hold. whew!> Was this a home visit or an office visit? or is there a code for parking lot visit? How many hours do you have to be in your car before it is considered your home? Does it matter that I never got in her car (home) with her?> Stew>