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November 6, 2019

Home Health Face-to-Face Primary Reason for Home Care

The actual Face-to-Face encounter visit must demonstrate that the encounter:

  • Was related to the primary reason that the patient requires home health services

According to the Centers for Medicare & Medicaid Services (CMS) Benefit Policy Manual Chapter 7, Section PDF—Supporting Documentation Requirements, the Face-to-Face encounter must be related to the primary reason for homecare. CGS medical review examines the Face-to-Face encounter to ensure the clinical documentation corroborates the primary reason for homecare. Please reference the examples provided by CMS in SE1436External PDF.

When reviewing Face-to-Face documentation thinkā€¦ Why Homecare, Why Now? Does the Face-to-Face encounter visit clinical documentation support this?

As a reminder always follow ICD-10-CM coding conventions when coding patient's primary and other diagnosis on the claim and plan of care.

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