visit without patient present

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North Swanzey, NH
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I'm trying to confirm that there is no way to bill a visit without the patient present to Medicare. I want to make sure I'm not missing something. I see in a prior discussion someone mentioning 99358. I had received information that a level E/M with the reason for the discussion as lead dx and V65.19 as second dx. Does anyone have documentation about this? Thank you
 

OCD_coder

True Blue
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938
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Nashville AAPC Chapter
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MCR requires at least a portion of the visit to be face to face when billing an E&M level. If time is used as the key controlling factor when selecting and E&M, the entire encounter must be face to face with the patient.
 

BEARDOG

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I'm trying to confirm that there is no way to bill a visit without the patient present to Medicare. I want to make sure I'm not missing something. I see in a prior discussion someone mentioning 99358. I had received information that a level E/M with the reason for the discussion as lead dx and V65.19 as second dx. Does anyone have documentation about this? Thank you
CMS guidelines and AMA guidelines are not always the same. On some EM visits (9920x and 9921x range) AMA guidelines state "...face-to-face with the patient and/or family". However, CMS guidelines dictate it must be face to face with the patient. 99358 states it is time spent "...before and/or after direct patient care..." You are not missing anything as I was on a similar search just a few weeks ago. The patient had severe dementia and the family wanted to talk with my surgeon about her breast cancer treatment options without the patient present as it was difficult to get her to appointments. We ended up not charging for the visit as she was a medicare patient and it was not allowable. I hope that was helpful, I know it was not encouraging. :(
 

rcorrigan

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Can anyone tell me the Correct TOB for billing when a specimen is sent to a CAH lab? patient is not present.
 
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