Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making
CPT4 code
Name of the Procedure:
Domiciliary or Rest Home Visit for Evaluation and Management of an Established Patient
Common name(s): Home Visit, House Call, Domiciliary Care
Technical/Medical terms: E/M Visit, Domiciliary E/M
Summary
A domiciliary or rest home visit is when a healthcare provider visits an established patient in their home or care facility to assess and manage their medical condition. This type of visit typically includes reviewing the patient's medical history, performing a physical examination, and making medical decisions regarding the patient's care.
Purpose
This procedure aims to provide medical care to patients who may have difficulty traveling to a clinic due to mobility issues, chronic illness, or other health-related factors. The expected outcome is to effectively manage the patient's medical conditions within the comfort of their living environment.
Indications
- Chronic illness or multiple comorbidities requiring frequent monitoring
- Limited mobility or homebound status
- Recent hospital discharge needing follow-up
- Complex medical conditions that necessitate comprehensive oversight
- Need for palliative or end-of-life care management
Preparation
- Patients should have a family member or caregiver present if possible.
- Compile a list of current medications and any recent test results.
- Ensure the home environment is conducive to privacy for the medical assessment.
Procedure Description
- Introduction and preliminary patient interaction to understand the primary concerns.
- Expanded problem-focused interval history review, updating any changes since the last visit.
- Expanded problem-focused physical examination tailored to the identified concerns.
- Medical decision-making based on the history and examination, which may include adjusting medications, ordering tests, or planning follow-up care.
- Documentation of the visit and any changes to the care plan communicated to the patient and caregivers.
Duration
Typically, 30-60 minutes depending on the complexity of the patient's condition.
Setting
The patient's home, assisted living facility, or rest home.
Personnel
- Primary healthcare provider, such as a physician, nurse practitioner, or physician assistant.
- Possibly accompanied by a nurse or medical assistant.
Risks and Complications
- Minimal risks associated with the actual visit.
- Complications could stem from the management of medical conditions, such as medication side effects or progression of the illness.
- Addressing emergent issues might be delayed compared to a clinical setting.
Benefits
- Personalized medical care in a comfortable and familiar environment.
- Reduced need for patient travel, which can be beneficial for those with mobility issues.
- Immediate assessment and adjustments of the care plan in response to the patient's current condition.
Recovery
- No recovery time required from the visit itself.
- Patients should follow any new instructions provided by the healthcare professional.
- Schedule and attend any recommended follow-up appointments.
Alternatives
- Telehealth visits: Useful for continual monitoring but lack the physical examination component.
- Office visits: Provide comprehensive care but require patient travel.
- Emergency room visits: Necessary for acute issues but not practical for routine management.
Patient Experience
- Patients generally experience minimal discomfort during the visit.
- The presence of the healthcare provider in the home can be reassuring.
- Pain management and comfort measures will be addressed as part of the care plan.