E/M code when Doc meets with Family ??

Orthocoderpgu

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Local Chapter Officer
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Salt Lake City, UT
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Here's the situation. Very elderly patient. Their relatives comes to the clinic to discuss and get advice about the patient since the patient can no longer take care of themselves and participate in their own management of care. Can this be billed? What code? Thanks for your suggestions.
 

bclegg

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Heber Springs, AR
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You can bill it as a regular established office visit E/M code as the CPT book states "counseling or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and or the family's needs. Physican's typically spend ____ minutes face-to-face with the patient and/or family." Since the patient may or may not be there, this would have to strictly be a time based coding with careful documentation of the time started, detailed documentation about what was discussed, and the time ending. Diagnosis of the patient's condition will also need to be documented. Now just because you bill it, depending on the carrier, does not necessarily mean you'll get paid.
Hope this helps!
 
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Milwaukee WI
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WHY can't patient be present and participate

I agree with bclegg, but just want to add ...

It's also important to document WHY the patient him/herself is unable to pariticpate in the medical decision making. Medically valid reasons include: dementia, coma, intubated, noncommunicative, etc (you get the idea).

The adult children of an elderly patient coming in to discuss "Mom/Dad's" case is by itself not sufficient documentation to make this a billable service (doesn't mean you can't charge the adult children a fee, just means you can't bill to Medicare).

Hope that helps,

F Tessa Bartels, CPC, CEMC
 

Karolina

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Also to consider is that the discussion has to focus on how to care for the patient. Discussion of coping mechanisms for the family (for example) is not considered part of the billable service.
 

cgallimore

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High Point, NC
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I have a question that is specifically related to this issue. Could these type visits be billable using CPT codes 99339 & 99340? I'm still a little fuzzy on when to use these codes vs the established patient codes for these type visits. I had a coworker state to use 90846 for this type of family 'counseling', but this is a psychotherapy code and these visits are not for psychotherapy counseling.

Thanks for the help!
 
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Milwaukee WI
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99339-99340 not

No, a visit with the patient's family to discuss the medical management of the patient is NOT reported with 99339 or 99340.

Use the established patient office visit code based on time spent in counseling/coordination of care.

F Tessa Bartels, CPC, CEMC
 
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