Question

question 13

a provider makes a home care visit to a 63-year-old hemiplegic patient who has been experiencing insomnia for the last two weeks. the patient has been home bound for the last year. the last visit from this provider was four months ago to manage his dm. the physician performs a medically appropriate examination and low mdm. the provider speaks with the spouse about the possibility of placing the patient in a nursing facility. what cpt® code is reported?

99342
99348
99203
99213

Explanation:

Determine the service location and patient status

• Location: Home visit ("home care visit", "home bound").
• Patient status: Established patient (the last visit from this provider was four months ago, which is within 3 years).
• Code range for Home Services, Established Patient: 99347–99350.

Analyze the level of Medical Decision Making (MDM)

• The provider performs a medically appropriate examination and low MDM.
• For established patient home visits (99347–99350), the code selection is based on the level of MDM or total time spent on the date of the encounter.
• Low MDM corresponds to CPT code 99348.

Verify the selected CPT code against options

• 99342: Home visit for a new patient, moderate MDM.
• 99348: Home visit for an established patient, low MDM.
• 99203: Office or other outpatient visit, new patient.
• 99213: Office or other outpatient visit, established patient.
• Therefore, the correct code is 99348.

Answer:

• 99342
• 99348 (Correct answer)
• 99203
• 99213