Wiki Visit with Parent- Patient not Present

[BrendaC1957]

Scenario:
The parent/legal guardian has a face to face visit with a provider regarding a minor patient who is not present in the facility. During the visit the provider discusses the minor patient's recent lab results and obtains a referral to a specialist.

How would this service be reported. If a specific CPT E & M cannot be suggested by the information I have provided- an E & M category would be helpful. Your reasoning/source for your suggestion would also be helpful.

Who's medical record would this visit be documented? The minor patient's chart or the parent/legal guardian's chart that had the face to face with the provider? I believe there would be a direct correlation of who's chart the documentation existed to who's insurance are you going to bill?

In this case, our provider documented in the minor patient's chart.

Thanks

 

[bsesender]

any help would be appreciated

Did you ever get an answer to your question? i am having the same dilemma.. would love to know the codes used and if you were paid from insurance

we were looking at 99402 and v65.19, but this is usually denied by insurance. the dx is appropriate, but not sure about the cpt

 

[mhstrauss]

I know this is an older thread, but hoping the 2 previous posters still get this response...
When billing for an E/M service for which the actual patient is not present, the Office/Outpatient Visit codes may be used, depending on the payer. Per CPT description for 99201-99215, "typically, X minutes are spent face-to-face with the patient and/or family". If the patient has Medicare, the visit is not billable; Medicare will only pay for E/M services that are face-to-face with the patient. If the payer is commercial, check their guidelines. We have had several of ours state that they will pay for visits that the patient's family came for (pt too sick to travel, long distances, etc.)

As far as who is considered the "patient"...of course, it is the person who is being treated...in this case, the child. The visit notes should go in the child's chart, and the claim gets filed to the child's insurance.


I would be hesitant to use the 9940X set as the second poster suggested; depending on the circumstance, of course. The OP indicated that there is a referral to a specialist, which makes it sound like a "problem", not "preventive".

Hope this helps!