E/M with mom of an established patient

sallen7113

Contributor
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Brunswick, Georgia
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We had a mother come in today to have get test results for her young daughter but the child was not present. The child is an established patient. Can we bill for this service if the results were given to her and explained by the physician?
 

LindaEV

Expert
Local Chapter Officer
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Kansas City, MO
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Unfortunately there is no clear cut answer in this (unless it was Medicare who says no...but it's probably not Medicare in your case). Some payers will pay, some won't.
 

mhstrauss

True Blue
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Baton Rouge
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The description in established E/M codes states "physicians typically spend X minutes face to face with the patient and/or family". This statement leads one to believe that a visit with the mother would be billable. However, it is probably best to check with the payer; as the previous replier stated, it probably isn't Medicare.

We did have one instance here in my clinic where the parents came in; we were told by the payer prior to the visit (it was Humana, if I'm remembering right) that the claim would be paid. We were doubtful, but the insurance did pay it. So it is possible.

Hope this helps!
 
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