Cindy01
Contributor
Patient's family comes in pediatrician speaks to them about the child's diagnosis and makes a plan with the family, can this be billed? Child was not present do to age and diagnosis?
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Pediatric counseling
- Thread starter Cindy01
- Start date
OpenClaims
Expert
I do not believe that this can be billed. Given that the child is the patient, and the patient was not present, that means that the patient was not seen. That would not constitute an encounter from my experience.
brucep
Contributor
I believe this can be billed. CPT defines total time for office/outpatient evaluation and management (E/M) services as including “both the face-to-face and non-face-to-face time personally spent by the physician and/or other qualified healthcare professionals [QHPs],” including “counseling and educating the patient/family/caregiver.” Under this situation, family counseling would qualify as non-face-to-face time. Further, CPT’s Counseling Guidelines state that "Counseling is a discussion with a patient and/or family,” (emphasis added). The “or’ here can be taken to mean that the patient does not have to be present.
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