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Ins and Outsof Geriatric House Calls

Identify the criteria to qualify as a house call patient compared to a home health patient.

Apply appropriate assessment tools, equipment, skills, and resources to improve the quality of care for house call patients.

Discuss methods to protect confidential patient information while making house calls.

Discuss correct billing locations and CPT codes for proper payment.

Determine needed tools, assessments, and billing location codes for 3 case studies with Q and A.

SocietyPatient

Caregiver

eyes, ears, hands and heart

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NutritionHousing

Immobility

Other people

Medications

Examination

Services

SafetySpiritual health Knight AL, Adelman AM. The family physician and home

care. Am Fam Physician 1991;44:1733–7.

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just keeps beeping … I don’t know what it is

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condiment refrigerator

CBD

“1 in 10 seniors binge drink” NYT 8-4-19

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Center for Healthy Aging

House Call Program

Home visits: new patients

99341 Low severity

99342 Moderate severity

99343 Moderate to high severity

99344 High severity

99345 Unstable

99347 Minor

99348 Low to moderate severity

99349 Moderate to high severity

99350 High severity

Established

New

99324 Low severity

99325 Low to moderate severity

99326 Moderate to high severity

99327 High severity

99328 High complexity

99334 Self-limited or minor

99335 Low to moderate severity

99336 Moderate to high severity

99337 Unstable or significant new problem

New

Establishedcodes

Initial NF care 99304-99306

Subsequent NF

care

88307- 99310

Discharge Day 99315-99316

Annual NF visit 99318

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Mary Thomas 70 yo John Stevens 82 yo Elaine Jones 78 yo

Medical Hx DM, CHF, HTN, memory loss, wound

HTN, old stroke, memory loss, incontinence

Lymphedema, HTN, hypothyroidism, verbal abuse

Mobility Ambulates poorly Bedbound Housebound

Location Assisted Living Home with spouse Condo with son

Travel Difficult trips to appts.

None. Metro, cab, ambulance

? Available Medications, Personal Care, PT,OT, Lab

Spouse and no help Usually on her own, has metro lift, hospital bed, scooter, acces. van

Insurance Medicare Medicare and Medicaid Medicare

Home Health/Provider

Assistance

Mary Thomas 70 yo New patient

John Stevens 82 yoEstablished Patient

Elaine Jones 78 yoNew Patient

Medical Hx DM, CHF, HTN, memory loss, wound

HTN, old stroke, memory loss, incontinence

Lymphedema, HTN, hypothyroidism, verbal abuse

Mobility Ambulates poorly Bedbound Housebound

Location Assisted Living Home with spouse Son lives in condo

? Available Medications, Personal Care, PT,OT, Lab

Spouse and no help Usually on her own, has metro lift, hospital bed, scooter, acces. van

Insurance Medicare Medicare and Medicaid Medicare

Code 99343-99345

Home Health

Provider

Yes for wound care-skilled nursing BP and CHF. DM teaching and monitoringSelf Pay

Assistance Walker, grab bars, raised toilet seat

Mary Thomas 70 yo New patient

John Stevens 82 yoEstablished Patient

Elaine Jones 78 yoNew Patient

Medical Hx DM, CHF, HTN, memory loss, wound

HTN, old stroke, memory loss, incontinence

Lymphedema, HTN, hypothyroidism, verbal abuse

Mobility Ambulates poorly Bedbound Housebound

Location Assisted Living Home with spouse Son lives in condo

? Available Medications, Personal Care, PT,OT, Lab

Spouse and no help Usually on her own, has metro lift, hospital bed, scooter, acces. van

Insurance Medicare Medicare and Medicaid Medicare

Code 99343-99345 99347-99349

Home Health

Provider

Yes for wound care-skilled nursing BP and CHF. DM teaching and monitoringSelf Pay

Yes – initially for needs assessment, PT and OT

Yes

Assistance Walker, grab bars, raised toilet seat

Hospital bed, transfer board, Hoyer, pads,

Mary Thomas 70 yo New patient

John Stevens 82 yoEstablished Patient

Elaine Jones 78 yoNew Patient

Medical Hx DM, CHF, HTN, memoryloss, wound

HTN, old stroke, memory loss, incontinence

Lymphedema, HTN, hypothyroidism, verbal abuse

Mobility Ambulates poorly Bedbound Housebound

Location Assisted Living Home with spouse Son lives in condo

? Available Medications, Personal Care, PT,OT, Lab

Spouse and no help Usually on her own, has metro lift, hospital bed, scooter, acces. van

Insurance Medicare Medicare and Medicaid Medicare

Code 99343-99345 99347-99349 99342-99345

Home Health

Provider

Yes for wound care-skilled nursing BP and CHF. DM teaching and monitoringSelf Pay

Yes – initially for needs assessment, PT and OT and as conditions change

Yes

Yes/No- pt achieves goals and it stops.Refuses care.

Self Pay

Assistance Walker, grab bars, raised toilet seat

Hospital bed, transfer board, Hoyer, pads, diapers, wipes, gloves

Motorized Wheelchair, Construction assistance, Lymphedema therapy,Hospital admissions

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