Wiki Legal billing ??

[riverwoodmed]

Question?? So can a provider bill a patients insurance (Office Visit) if the provider is speaking to a family member only (patient is not present) about the care of the patient?? The provider billing patient insurance office visits when patient is not present? only a family member is present?

 

[wfriddle]

Yes

If you look at the code descriptions for office visits you will see it is OK to bill out an office visit for counseling a family member.
for example...
Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family.

The provider would just have to follow the guidelines for coding based on time. The amount of time spent counseling as well as what was counseled would definitely need to be documented.

 

[thomas7331]

Although CPT states that the time can be with the patient and/or family, Medicare does require that the patient be present in the office setting, so if this is a Medicare patient, you can't use the time-based billing for meetings with the family. From Chapter 12 section 30.6.1 of the Medicare Claim Processing Manual: "In the office and other outpatient setting, counseling and/or coordination of care must be provided in the presence of the patient if the time spent providing those services is used to determine the level of service reported."