Medical care for mentally handicapped

mnco

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Location
Lawrenceburg, IN
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One of our physicians asked the following billing question: There is a patient who is mentally handicapped but also has cancer. The patient's parents want him to have oncology treatment, however, they say the patient gets very anxious and upset in MD offices. The parents would like to meet with our physician without the patient to discuss the diagnosis and treatment plan. Obviously, there would be no exam and the history would be from parents and not the patient. Has anyone billed for this type of situation? Would this be the appropriate use of 99499 - unlisted e/m service?
Thanks.
 
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4,456
Location
Milwaukee WI
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Patient must be present

If the patient has Medicare, the patient must be present to bill a face-to-face visit. Is it possible to have this "conference"in a conference room or physician office within the suite, and not in an exam room? This slight change of location may be all that's needed to help the patient remain calm. (Oh, and the physician might want to go without the white lab coat for this visit, too.)

The level of visit will be determined based on the time spent in counseling/coordination of care, so be sure the documentation clearly meets those requirements.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 

kari2007

Networker
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34
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Look at Prolonged services without direct patient contact if the patient has recently been in.
 
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