Office Visit w/Family Member


Best answers
Does anyone know if we can code and bill a 30 minute office visit with a family member of a current patient. The patient was not present at the office visit due to illness.

Thank you in advance.

James Carey
Milwaukee WI
Best answers
Counseling/Coordination of Care

CPT 2008 professional edition, page 8 states:
When counseling and/or coordination of care dominates (more than 50%) the physician/patient and/or family encounter (face-to-face time in the office...) ... (emphasis added by FTB)

So, yes you can code the E/M level based on counseling/coordination of care provided the physician documents:
1) total time spent face to face w/ family
2) amount of time spent in counseling / coordination of care (must be MORE than 50% of total time)
3) nature of the counseling/coordination of care.

ADDITIONALLY, if the patient cannot participate in the session, your documentation should state WHY the patient is not able to participate. (If the patient is home with a cold, I don't think this will be considered reasonable.)

Whether you can bill this is much more complicated. I work in a pediatric setting, so the only time I have used this with a MediCare patient was a case where the patient was in the ICU in a coma and the "counseling" took place in the ICU's conference room. (In an inpatient setting, time spent "on the unit" is still considered face-to-face for most carriers.)

I have applied this coding guideline, however, in cases of children with major physical anomalies or developmental delays, where parents come in to see the physician without the child present.

F Tessa Bartels, CPC, CPC-E/M