Wiki CPT and E/M codes for billing without a patient present

[lwhittiker]

Internal medicine practice sees family members in regards to patient health but patient was not present. How do I bill this appropriately for reimbursment from Medicare?

 

[SharonCollachi]

You don't. It's included in the E&M Code for the actual patient visit. CPT Book states, "The levels of E/M services include examinations, evaluations, treatments, conferences with or concerning patients..."

 

[csperoni]

My understanding is that for Medicare, the patient must be present, and is not billable if no face-to-face encounter with patient takes place. SOME private carriers may allow it, but I never found one. We decided the 3 times a year this occurs, it was not worth 2 hours of research each time to figure out if we might get paid $40.
CPT code 90887 Interpretation or explanation of results from psychiatric, OTHER MEDICAL EXAMS & PROCEDURES, or OTHER ACCUMULATED DATA to FAMILY or other responsible persons, or advising them how to assist patient (my caps for emphasis on relevant phrases) seems like it would be the accurate code, but it falls under the heading of "Other Psychiatric Services or Procedures". Additionally, Medicare bundles that code with any other E/M services (on any day, not just same day) and does not pay.
Here are a few references - all stating not payable for Medicare, but possibly for commercial insurance.
https://www.codapedia.com/article_179_Family_meetings_without_the_patient_present.cfm
https://acpinternist.org/archives/2008/11/coding.htm
https://www.physicianspractice.com/billing-family-meetings

 

[SharonCollachi]

My understanding is that for Medicare, the patient must be present, and is not billable if no face-to-face encounter with patient takes place. SOME private carriers may allow it, but I never found one. We decided the 3 times a year this occurs, it was not worth 2 hours of research each time to figure out if we might get paid $40.
CPT code 90887 Interpretation or explanation of results from psychiatric, OTHER MEDICAL EXAMS & PROCEDURES, or OTHER ACCUMULATED DATA to FAMILY or other responsible persons, or advising them how to assist patient (my caps for emphasis on relevant phrases) seems like it would be the accurate code, but it falls under the heading of "Other Psychiatric Services or Procedures". Additionally, Medicare bundles that code with any other E/M services (on any day, not just same day) and does not pay.
Here are a few references - all stating not payable for Medicare, but possibly for commercial insurance.
https://www.codapedia.com/article_179_Family_meetings_without_the_patient_present.cfm
https://acpinternist.org/archives/2008/11/coding.htm
https://www.physicianspractice.com/billing-family-meetings

Great call. I would bet the part I noted in red will get it denied for any number of providers, if the insurance company does not have them listed as a psych provider.