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. The service provided must satisfy, at a minimum, all of the requirements of an intermediate assessment.
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;
iii. Cognitive impairment (e.g. dementia or delirium);
iv. Age-related reduced mobility or falls; and/or
v. Unexplained functional decline not otherwise specified.
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.
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.
Please reference the billing pre-amble for these relevant interpretations of this billing code: