Otolaryngology Coding Alert

Question: A patient's father came in to review test results without the child present. Should the otolaryngologist charge an E/M service? Is a patient exam a requirement of an E/M service?


Ohio Subscriber


Answer: When counseling and/or coordination of care dominates a visit, you may use time as the controlling factor in selecting an E/M code, according to CPT E/M Services Guidelines. Time-based coding trumps all typical E/M components of history, examination and medical decision-making. So your otolaryngologist may report an E/M service, such as an office visit (99212-99215, Office or other outpatient visit for the evaluation and management of an established patient -), without performing an exam.

Problem: Medicare requires a patient to be present to bill an E/M service. For visits without the patient present, you should charge the service to the family member or treat it as a courtesy. Private payers may not require patient presence.