Primary Care Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: A patient came in to discuss the supportive care of her mother, a Medicare recipient who is also our patient. Should I use the confirmatory consultation codes (99271-99275) for this visit?

Alabama Subscriber

    Answer: The confirmatory consultation codes are not appropriate in this case because they apply only when the physician gives a second or third opinion on the necessity of a previously recommended medical treatment or surgical procedure. The doctor may be advising the patient about her mother, but if it is not to confirm the appropriateness of a previously recommended treatment, it is not a confirmatory consultation.
 
Although CPT states, "face-to-face with the patient and/or the family" in the E/M code descriptors, Medicare reimburse only for services delivered directly to the patient. The same is true for the majority of commercial and third-party payers. Therefore, since the Medicare recipient was not present during this visit and no E/M services were provided, the encounter is not billable to Medicare.
 
You should consider this visit a service to the patient who is in the office, i.e., the daughter. You can bill the visit as an E/M service (99212-99215) based on the time spent counseling. For the diagnosis code, use either V61.49 (health problems within family; other), which includes care of or presence of a sick person in the family or household, or V65.1 (person consulting on behalf of another person), which includes advice or treatment for a nonattending third party. If the payer does not reimburse for these codes, you can bill the patient.