Wiki OV to discuss child behavior

[nc_coder]

In the last week, one of our physicians has had 2 mothers come in to discuss the behavior of their child. Both of these visits were scheduled and billed under the child's name. Neither child was in the office at the time of the visit.
I remember reading somewhere that the patient had to be in the office even if they were not present in the room while a family member discussed care with the provider. I cannot remember where I read it and my providers and office manager will not listen to coding guidelines unless I have something in writing from a credible source to back up what I am telling them.
Can anyone help me with this? Am I wrong? Or does anyone know where I can find this guideline in writing?

Thanks for your help.

 

[Melissasuewashburn]

I don't have a real answer for you, however I did find the following that might be a springboard for some further research:

https://www.aapc.com/memberarea/forums/showthread.php?t=5045

http://www.physicianspractice.com/pearls/billing-family-meetings

Everything I found on this issue makes it seem like it might be based on the individual insurance as Medicare doesn't allow for an E/M to be billed if the patient isn't present, however some private insurance may. Also, everything I found definitely states that it would be billed under the patient's name (not the parent, caregiver, etc) or it could be constituted as fraud. I did also find that you would use a V code in addition to the DX for the conditon the counseling is for - V65.19 ”other persons seeking consultation; other person consulting on behalf of another person.”

I would most likely call the insurance provider involved and get guidance from them.

 

[nc_coder]

Thank you for your response. It was very helpful. Now that I think about it, I believe I was reading something on the Medicare website that said we could not bill for those types of visits.