Pediatric Coding Alert

Question: How should I bill for a physician who performs a 30-minute consultation with a parent when the patient isnt present?

Ohio Subscriber

 
Answer: As long as this is an established patient, you can bill for this visit with an E/M code. Use time as the key factor in selecting a level.
 
Normally, you would have to satisfy two of the three criteria patient history, examination and medical decision-making to bill any E/M code. But when there is a medical reason for the parent to discuss the case with you alone, perhaps with the child in the waiting room or even at home, then you can bill for the visit based on time.
 
Time indicators in CPT are: 99211 (five minutes), 99212 (10 minutes), 99213 (15 minutes), 99214 (25 minutes) and 99215 (40 minutes).
 
Document the time spent with the parent. Consider the diagnosis carefully; a diagnosis of asthma is more likely to justify a high-level E/M than a diagnosis of upper-respiratory infection, for example.
 
In the introduction to the E/M section of CPT, it is clear that counseling may be with the patient or the family, or both. 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, CPT states, giving as examples foster parents, persons acting in locum parentis, or legal guardians.