Look at the payer's medical policies. Most major carriers require face-to-face time with the patient to bill an E&M. If the carrier follows Medicare guidelines, then this service is not billable. If they follow CPT guidelines, then the CPT Assistant information would be accurate and appropriate.
Novitas-Solutions - E&M Frequently Asked Questions~
24. The March 2013 CPT Assistant Professional Edition, (page 8), states that providers may bill an office/outpatient Evaluation and Management (E&M) visit (99211-99215) for meeting with a patient’s family, to discuss the patient’s care, without the patient present. Is this appropriate billing under the Medicare program?
No, billing office/outpatient E&M services (99211-99215), in the absence of the patient, is not billable under the Medicare program. Please refer to Internet Only Manual Publication 100-02, Chapter 15 ?30(A) and Claims Processing Manual, Publication 100-04, Chapter 12, ?30.6.1.
Date Posted: 04/30/2013, Date Reviewed: -11/15/2013
Palmetto~
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 12Adobe 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 )