Reader Question: Family Consult

Question: I know that CPT 2000 just attempted to clarify the billing rules for charging a consult for doctors who spend a lot of time consulting with the patients family, but I am still hearing that I should avoid billing this. Can you give me some examples of when this might be appropriate in an infectious disease setting?

Michigan Subscriber

Answer: CPT 2000s evaluation and management (E/M) guidelines section attempted to clarify the rules for billing E/M codes for family consultations, but many coders still are confused. CPT 2000 states, When counseling and/or coordination of care dominates (more than 50 percent) the physician/patient and/or family encounter (face-to-face time in the office or other outpatient setting or floor/unit time in the hospital or nursing facility), then time may be considered the key or controlling factor to qualify for a particular level of E/M services. This includes time spent with parties who have assumed responsibility for the care of the patient or decision-making whether or not they are family members ... The extent of counseling and/or coordination of care must be documented in the medical record.

Coding a consult for counseling with a patient or with a patients family about the patients condition or plan of treatment/action is appropriate as long as the documentation is complete. The billing should be based on time if the key components of history, exam and decision-making do not support what you may consider an appropriate consult level. Basing the coding on time also requires specific documentation this is where physicians typically fall short.

It is appropriate to base coding on time only if counseling constitutes 50 percent or more of the visit time. According to the guidelines, the chart documentation must confirm that counseling dominated the patient visit. You can satisfy the 50 percent requirement by stating the total time with the patient as well as the time spent in counseling.

You can record the time by having the doctor report the actual time he or she saw the patient for counseling. For example, the chart might read, Total time = 8:00 a.m. to 9:00 a.m.; Counseling time = 8:15 a.m. to 9:00 a.m. As an alternative, the doctor could simply indicate the number of minutes spent with each e.g., Total time = 60 minutes; counseling time = 45 minutes. Either approach establishes the percentage of time spent counseling the patient or patients family.

- Published on 2000-06-01