Billing Family Consults

ninchik

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In Pediatrics' setting, how do you bill family consults where the patient is not present? We were given directives in the past about not being allowed to bill new patients or consults if the patient was not present, but given what we know of CPT guidelines, I think this is not correct. Does Medicaid have anything in their policies about it and what kind of documentation guidelines needs to be there on how to describe the time spent?
Thank you for you time and help.
 

trarut

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Not in Peds but we've had a similar question over the years. We have Medicare patients and Medicare does not allow billing of an E/M service when the patient is not present.

I've asked about billing family consults with a 99499 and was advised by a consultant tit would be best to treat the encounter as a self-pay service, similar to the way many practices handle things like sports physicals. That best practice is to set a flat fee, have a form that is signed to acknowledge we will not bill insurance and collect the fee up front - and include the policy in our compliance plan.

I don't know how helpful that information is to you but I'll be watching to see what other responses you get :)

Tracy
 
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