Wiki Can I bill E&M if pt was not in office??

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rjenn86

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Hi Everyone, I have a question that I hope someone can answer for me?

I have a doctor who saw pt's parents in office to give them the post MRI results (Patient was not present). He charged a 99212, and according the the face to face time guideline in the cpt book it states we can bill an E&M if face to face time is spent with the pt and/or family. (If I'm reading that correctly). My question is can will bill that E&M 99212? Thank you
 
As per my knolwledge you can bill the e/m code, since the pt's family members are visited.
I hope it will help you.



Thanks
Ravikiran.N
United Health Group
 
Hi Rachel, this exact question was asked this forum last month. Here's my response:

You might think the answer is yes, but it's not. Yes - the CPT guidelines say that time may be considered when counseling or coordination of care dominates the encounter. Yes - The counseling can be with the patient and/or the family - but the family counseling must still be done in the context of a patient encounter. For example, you spend some time evaluating the patient who is unconscious or somnolent, then spend some time discussing the prognosis or plan of care with the family in the next room. That time may be counted. The provider isn't limited because the patient is unconscious and not able to participate in the counseling - it is medically necessary (for the patient's care) to have that discussion with the family.
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Here is a quote from the Medicare Claims Processing Manual Chapter 12 Section 30.6.1 Part C - "Selection of Level of Evaluation and Management Service Based on Duration of Coordination Of Care and/or Counseling"

In the office and other outpatient setting, counseling and/or coordination of care must be provided in the presence of the patient if the time spent providing those services is used to determine the level of service reported. Face-to-face time refers to the time with the physician only. Counseling by other staff is not considered to be part of the face-to-face physician/patient encounter time. Therefore, the time spent by the other staff is not considered in selecting the appropriate level of service.
Click to expand...

This confirms that if you are selecting the level of service based on time spent counseling or coordinating care in the office setting, the patient must be present - even if you are counseling the family. I really cannot recommend billing an E/M service for a patient who was not present.
 
I must agree with Mike Enos and add, many commercial carriers follow the same policy (the patient must be present) so be sure to check with them how they want family counseling billed.

I found this recently on WPS-MAC website:

Q13. We met with the family of a pediatric patient to provide counseling/coordination of care and did not see the patient. Can we bill this visit to Medicare under the pediatric patient's Medicare number? Is this considered family counseling and therefore billed under the mental health services?

A13. Counseling/coordination of care is face-to-face time with the patient. (Reference: CMS IOM Publication 100-04, Chapter 12 Adobe Portable Document Format, Section 30.6.1.C)

Medicare can allow a charge for time spent with the family in only two situations:

1. The physician is asking the family for history or discussing the options for the patient’s care when the patient is incapable of participating

2. The services would fall under the mental health counseling provision of Medicare.
(Reference: IOM Publication 100-03, Chapter 1, Section 70.1.Adobe Portable Document Format )
 
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