E/M Visit - Patient not present at visit.

wverret

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Can provider bill for E/M office visit when the patient was not present? Physician met with parents of severely disabled young adult. The patient did not accompany them to the office visit.

Below is a typed copy of the note.

Patient: John Doe
Age over 30
Established patient
DOS: 2013


Subjective Findings:
John Doe’s parents are in for an appointment regarding John Doe. John Doe has been QT chromosomal abnormality, autism spectrum disorder C are severe intellectual disability, global developmental disorder, adult growth hormone deficiency hypotonia, osteoporosis and scoliosis and oral motor dyspraxia.

He is currently taking vitamin K twice daily for osteoporosis. He was on alendronate for approximately 6 years. This was subsequently discontinued. He is taking calcium supplement as well as a vitamin D supplement. He is also on growth hormone adult growth hormone deficiency.

His most recent 1 just one reviewed. Treatment plan reviewed with parents.

Problem list: (all are identified as chronic)
Hypotonia
Global Developmental delay
Mental retardation
Acne
Cerebral palsy
Osteoporosis
Autism
Growth hormone deficiency
Abnormal chromosome

Past Medical/Surgical History
Anoxia at birth/pneumothorax
Cryptorchidism-orchiopexy and hernia repair
Far sighted
Hip fracture right femoral neck nondisplaced
Infection left inguinal hernia
Right knee fracture
Right knee injury (medial collateral ligament
Surgery for rectal prolapse
Surgery upper spine, scoliosis

Diagnostic History
Dexi Scan


Family History:
Reviewed, no changes. Last detailed document xx/xx/2012

Social History:
Reviewed no changes. Last detailed document date xx/xx/2012

Allergies:
Droperidol
Meperidine HCL
Benzodiazepines

Labs results received last 30 days:
Vitamin D, 25-Hydroxy,LC/MS/MS
Lab values listed here

IGF I, LC/MS
Lab values listed here

Lipid Panel
Lab values listed here

Comprehensive Metabolic Panel
Lab values listed here

Assessment/Plan
Osteoporosis (733.00) chronic
Pituitary dwarfism (253.3) chronic

John Doe is scheduled in the near future for repeat bone density Test if he has fallen bone density would discuss treatment options which include Prolia. Currently will continue on over the counter treatment. Parents reassured. Total time spent with x 30 min.
Medications:
Current medications listed here

Counseling/Education Factors:
Counseling/Education factors reviewed

Provider: Doctor’s name, MD
Authenticated by Doctor’s name, MD on xxx date
 

thomas7331

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Medicare guidelines do not allow coverage for office E&M services unless the patient is present for a face-to-face encounter. I've heard that some other payers do allow it, but I couldn't tell you for sure if that's the case.
 

wverret

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Pt. Not present

Thomas,
Thanks for your response. FYI, this patient is not a Medicare enrollee. Has just Oregon Medicaid.

Willie

Medicare guidelines do not allow coverage for office E&M services unless the patient is present for a face-to-face encounter. I've heard that some other payers do allow it, but I couldn't tell you for sure if that's the case.
 
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What exactly was the reason for the encounter? I see one statement "Treatment plan reviewed with parents" without elaboration. The section dedicated to "Counseling/Education Factors" is blank.

The CPT book does say "with the patient and/or family" for office visits, but I read someplace a while back that a few payers may allow for billing without the patient under extenuating circumstances, this being an example. I highly doubt MD of Oregon is one of those few.

Regarding codes 99358 and +99359; they must accompany an E/M visit in which face-to-face contact occurred or will occur and be directly related to the services of the E/M visit or the ongoing treatment of the patient. Based on the CPT guidelines (specifically on page 8 of the 2016 AMA Prof Ed), I don't think an office visit with the parents would qualify for this type of service. Regardless, they're more than likely not payable any way.

The only other idea that I can think of is MAYBE 90846 Family psychotherapy (without the patient present), primarily because of the number of psychiatric/mental health conditions the patient has. When I pull up that code, I get:
"A provider or qualified psychotherapist meets with a patient’s family without the patient present to counsel the family members and help them understand the patient’s problem and how they respond to the patient can negatively affect or benefit the patient. The emphasis during family psychotherapy is on the patient's care and the family’s involvement in the patient’s treatment. The therapist may discuss family dynamics as they relate to the patient including family interaction and communication and conflict resolution." I have no idea if this would fly or if its payable for MD of Oregon.
 

wverret

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Danskagel313

Thanks for the information. I looked at the psych codes and I don't think that's the right code. The doctor is an Endocrinologist. However, you gave me a lot of things to think about.

Thank you very much.
Willie

What exactly was the reason for the encounter? I see one statement "Treatment plan reviewed with parents" without elaboration. The section dedicated to "Counseling/Education Factors" is blank.

The CPT book does say "with the patient and/or family" for office visits, but I read someplace a while back that a few payers may allow for billing without the patient under extenuating circumstances, this being an example. I highly doubt MD of Oregon is one of those few.

Regarding codes 99358 and +99359; they must accompany an E/M visit in which face-to-face contact occurred or will occur and be directly related to the services of the E/M visit or the ongoing treatment of the patient. Based on the CPT guidelines (specifically on page 8 of the 2016 AMA Prof Ed), I don't think an office visit with the parents would qualify for this type of service. Regardless, they're more than likely not payable any way.

The only other idea that I can think of is MAYBE 90846 Family psychotherapy (without the patient present), primarily because of the number of psychiatric/mental health conditions the patient has. When I pull up that code, I get:
"A provider or qualified psychotherapist meets with a patient’s family without the patient present to counsel the family members and help them understand the patient’s problem and how they respond to the patient can negatively affect or benefit the patient. The emphasis during family psychotherapy is on the patient's care and the family’s involvement in the patient’s treatment. The therapist may discuss family dynamics as they relate to the patient including family interaction and communication and conflict resolution." I have no idea if this would fly or if its payable for MD of Oregon.
 
Messages
811
Best answers
0
Danskagel313

Thanks for the information. I looked at the psych codes and I don't think that's the right code. The doctor is an Endocrinologist. However, you gave me a lot of things to think about.

Thank you very much.
Willie

I'm not certain that it matters about the specialty. I don't have my book in front of me, but I think the guidelines didn't restrict it down further than "a provider". I could be wrong.
 
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