Wiki family visit without patient present

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jpierce31

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Dr R is seeing a patients son this afternoon to discuss her condition. She is in a nursing home and demented and cant come to the appointment. Is this a billable appointment and if so what is the CPT code?
 
You bill the appropriate office visit (POS 11) E&M code based strictly on time. Dr R needs to document: who he spoke with, what the overall gist of the discussion/counseling/prognosis/treatment/etc. is for the patient/mom that is not present. Identify all of this and explicitly state how much time was spent in the discussion - then choose the corresponding 9921x based on time. You can do this when greater than 50% of the time is spent on counseling/education/etc. vs. physical exam, history, etc.
 
Actually if the patient has Medicare coverage, this would not be billable. Per CMS guidelines, time-based billing must be face-to-face time with the patient (or floor time if the physician is seeing the patient in the facility). If the patient is not present in the office, the physician may not use time for E&M billing and it would not be a Medicare covered service. See the Medicare Claims Processing Manual, Chapter 12.
 
thomas7331 said:
Actually if the patient has Medicare coverage, this would not be billable. Per CMS guidelines, time-based billing must be face-to-face time with the patient (or floor time if the physician is seeing the patient in the facility). If the patient is not present in the office, the physician may not use time for E&M billing and it would not be a Medicare covered service. See the Medicare Claims Processing Manual, Chapter 12.
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What if the patient wasn't medicare? Office visit like above?
 
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