Pulmonology Coding Alert

Question: What is the best way to code for a family consult when the patient is not present (no face-to-face contact)? The patient is a nursing home patient whom our pulmonologist saw, and the family wants to come in to discuss the best care.South Carolina Subscriber
 
Answer: If this is a Medicare patient, you won't be able to charge for a consultation. Unless included in the specific exception (Chapter 1, Part 1, Section 70.1 of the Medicare Benefit Policy Manual), Medicare pays only when the patient is present, and you won't find a way around this.You can bill the family for the visit, or you can have the family present at the nursing home with the patient in the room when the physician performs the service. This would not meet the requirements for coding a "consultation" but rather a subsequent nursing facility visit (99307-99310).The important thing in this situation is that the physician has face-to-face contact and evaluates the patient, when possible along with discussing treatment options with the patient's family.Check it out: To view the Medicare consult exception referenced in this reader question, go to the CMS site www.cms.hhs.gov/manuals/downloads/ncd103c1Part1.pdf.