House Calls: General information and billing

General information about house calls

A house call is a physician visit made to the patient in their own home. This may include anyone who can't or shouldn't come to the office to see the doctor for reasons such as disability, dementia (may forget their appointments) or VRE positive. House calls may last anywhere from 15 to 60 minutes depending on the complexity of the case. Patients should be treated as if they were in the office; for this it is important to be open and adaptable to the environment and ensure you pack the appropriate equipment. Some suggestions of what you need to take with you include:

• Hand sanitizer
• Flashlight
• Stethoscope
• Anaeroid BP monitor and selection of cuffs (pediatric, standard and large)
• Portable Otoscope and ophthalmoscope
• Tongue depressors
• Ear speculums and lighted ear curettes
• Tuning forks
• Bandage scissors
• Tape measure
• Gloves and lubricant
• Alcohol swabs, bandaids
• Urine bottles, C&S swabs and specimen bags
• Lab requisitions, X-ray requisitions, Prescription pad
• Dementia and depression screening tools (e.g. Montreal Cognitive Assessment, Geriatric
Depression Scale)
• Community DNR forms
• Medication flow sheets
• Patient chart (paper or laptop for EMR)
• Waterproof pads (for any procedure or exam that could dirty the patient’s furniture or bed, and to
put bag on)

Before conducting house calls it is important to consider your safety. You should be comfortable going to the patients home and should not feel concern to be surrounded  by any of the other occupants of the home. Ensure to list your house calls on your day sheets or leave the addresses with someone at all times. Other cautionary notes include steering clear of any pets you may be uncomfortable with by simply asking the patient to put the pet in a separate room and avoid tag along bed bugs!

Reference: Caroline A Knight MD CCFP FCFP

House Call Billing Codes (OHIP Schedule of Benefits)

House call assessment: A house call assessment is a primary care service rendered in a patient’s home that satisfies, at a minimum, all of the requirements of an intermediate assessment.

A901 House call assessment............................................................................................ $45.15

Payment rules: A house call assessment is only eligible for payment for the first person seen during a single visit to the same location. Services rendered to additional patients seen during the same visit are payable at a lesser fee; i.e. bill as an in office assessment.

Complex house call assessment: A complex house call assessment is a primary care service rendered in a patient's home to a patient that is considered either a frail elderly patient or a housebound patient (defined below). The service provided must satisfy, at a minimum, all of the requirements of an intermediate assessment.

A900 Complex house call assessment ............................................................................. $45.15

Payment rules: A complex house call assessment is only eligible for payment for the first person seen during a single visit to the same location.

1. A frail elderly patient is defined as:

a. 65 years or older with one or more of the following age-related illness(es), condition(s) or presentation(s):
     i. Complex medical management needs;
     ii. Polypharmacy;
     iii. Cognitive impairment (e.g. dementia or delirium);
     iv. Age-related reduced mobility or falls; and/or
     v. Unexplained functional decline not otherwise specified.

AND

b. resides in a home that includes:
     i. The patient's home; or
     ii. Assisted living or retirement residence (but does not include a long-term care home).

2. A housebound patient is defined as:

a. A person will be considered homebound where all the following criteria are met:
     i. The person has difficulty in accessing office-based primary health care services because of medical, physical, cognitive, or psychosocial needs/conditions;
     ii. Transportation and other strategies to remedy the access difficulties have been considered but are not available or not appropriate in the person's circumstances; and
     iii. The person's care and support requirements can be effectively and appropriately delivered at home.

Medical record requirements: Complex house call assessment is not payable If the medical record does not:
1. Demonstrate that an intermediate assessment was rendered; and
2. Demonstrate that the patient was a frail elderly or housebound patient.

House call assessment - Pronouncement of death in the home: A house call assessment - Pronouncement of death in the home is the service rendered when a physician pronounces a patient dead in a home. This service includes completion of the death certificate and counselling of any relatives which may be rendered during the same visit.

A902 House call assessment - Pronouncement of death in the home.............................. 45.15

Claims submission instructions: Submit the claim using the diagnostic code for the underlying cause of death as recorded on the death certificate.

Special visits and travel premiums for house calls

Note:
1. The maximum number of services per physician per day for B960 is 2, for any combination of non-elective and elective visits.
2. The maximum number of services per physician per day for B990 is 10, for any combination of non-elective and elective visits.
3. Special visit to patient’s home premiums are only eligible for payment for first patient seen, regardless of number of patients seen during one visit to a home or to one or more living units in a multiple resident dwelling. A multiple resident dwelling is a single location that shares a common external building entrance or lobby e.g. apartment block, rest or retirement home, commercial hotel, motel or boarding house, university or boarding school residence, hostel, correctional facility or group home.

House call bonus

**PLUS 20% premium on value of claims for house call visits in excess of level C if at least 75% house calls are A900 (Complex house call).

Note:
1. No bonus or premium for FFS
2. FFS, CCM, FHG, FHN - house calls are OUT of basket (pay 100%)
3. FHO - A900, A901, and special visit premiums are IN basket (pays 15%), Travel premiums are OUT of basket (pay 100%). A902 (and all palliative care) is OUT of basket

Reference: OHIP Schedule of Benefits and Caroline A Knight MD CCFP FCFP