Wiki Patient on phone, representative in office

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KarlieElwood2024

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Hey all! I am stumped and could use some help. We had a provider scheduled to see a patient. The patient's wife was at the appointment in person, but the patient was on the phone. I am totally lost on how to code this. Is it a telehealth since the patient was on the phone? Is it considered in office since there was a representative in the office meeting face to face with the provider? Any direction on this matter would be much appreciated!
 
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Hi there, could you give some more information about why the patient didn't show? It sounds like a telephone E/M to me but maybe there's something I'm missing.
 
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Agree, we would need more info on this. What type of service? There could be a lot of different answers to this. Was it family or marital counseling, a sick office visit, specialist, etc. etc. etc. Why would the wife be there?
 
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As a general rule, you will code the claim based on the location of the individual who is receiving the services. If the patient is the one being evaluated and treated by the physician, then code and bill based on the patient's location. The location of the representative is not relevant if they are not also being evaluated or treated. But as the above posts mentioned, there may be exceptions to this, for example with codes that describe services that also include family members or caregivers.
 
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Thank you for responding! It was a cardiology visit. The patients wife is an employee at the hospital so she was able to easily sneak over to the appointment, but it was never documented why the patient himself wasn't able to attend. The visit was scheduled as an in person visit and not a telehealth by the front office staff.
 
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karkieselwood@gmail.com said:
Thank you for responding! It was a cardiology visit. The patients wife is an employee at the hospital so she was able to easily sneak over to the appointment, but it was never documented why the patient himself wasn't able to attend. The visit was scheduled as an in person visit and not a telehealth by the front office staff.
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OK. It sounds like a missed appointment to me.

The conversation with the patient might be a telephone E/M visit if it met all of the requirements (and the payer covers them). But I'm really not sure about that and am interested to see what other folks think.
 
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Did the provider even intend for this to be billed? Sort of sounds like a "hallway consult" or just helping out an employee type deal. The ramifications and other implications aside...
Sounds a little fishy and something I would ask the provider about and I probably wouldn't feel comfortable billing it.
 
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To me, it seems like it is an audio only telephone visit 99441-99443.
I will note, even if it was easy for the wife to be present, since she's not the patient, I would consider it practically irrelevant to coding this scenario.
 
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