Wiki billing based on time - without the pt present

[Colliemom]

One of our physicians counseled a patient's mother regarding the patient's care. (17 year old) She wants to check and see if this is billable:

I had an appointment with a 17 YO girl but her mother was the only one to come to the appointment. I did spend at least 30min in discussion with the patient's mother, but of course could not examine the actual patient. what do I do with this from a billing perspective? Can I bill at all given that the patient was not even present for the discussion?

I had one source tell me:

"You can bill the mother directly using the counseling code without patient present. It is not covered by insurance."

CPT states, under Time guidelines, Face-to-face time is defined as only that time that the physician spends face-to-face with the patient and/or family. So does the "and/or" mean we can still bill for the time spent counseling the mother about the daughter's care? Does the fact that the daughter was not present effect this?

 

[pamtienter]

We follow CPT in these instances and bill the E/M since it says "patient and/or family" except for Medicare. Medicare doesn't cover these visits because they require a face-to-face with the patient.

 

[Karolina]

This is billable per CPT, however it will not be paid by every payer - I agree with Pam.

 

[Colliemom]

Thank you! The Pt has a commercial ins. so we are going to try billing the visit. I appreciate the input!

 

[FTessaBartels]

Patient name

You bill under the patient's name (in this case the 17 YO girl).
Documentation should state:
Total amount of time spent face-to-face with patient and/or family
Amount of time spent in counseling/coordination of care (must be MORE THAN 50% of total)
Nature of counseling/coordination of care
Some statement as to why the patient was unavailable (this should be a medically necessary reason, not just "didn't want to skip school")

Example: I spent 30 minutes with Mom today discussing Daughter's condition and treatment options; 100% of the time was for counseling/coordination of care. Due to the nature of the illness, Mother wished to discuss treatment options with me before meeting with her daughter.

Code the appropriate level E/M based on the total amount of time spent.

F Tessa Bartels, CPC, CEMC