visit without patient

efuhrmann

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I know what CPT says but does Medicare have any rule concening the visit must be face to face with the patient, not the family without the patient? Time spent counseling as the supporting documentation.
 

RebeccaWoodward*

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Selection of Level Of Evaluation and Management Service
Instruct physicians to select the code for the service based upon the content of the service. The duration of the visit is an ancillary factor and does not control the level of the service to be billed unless more than 50 percent of the face-to-face time (for non-inpatient services) or more than 50 percent of the floor time (for inpatient services) is spent providing counseling or coordination of care as described in subsection C.

30.6.1

http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf
 

efuhrmann

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thanks

Thank you for the reference-I was still researching it in between debating with my boss on the subject! Now I have some ammunition. Some days I feel like I really am in a battle of sorts.
 

RebeccaWoodward*

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Glad I could help. Here's one more link in the event you come across any static.

http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5972.pdf

Prolonged Services Associated With E&M Services Based Counseling and/or Coordination of Care (Time-Based)

When an E&M service is dominated by counseling and/or coordination of care (the counseling and/or coordination of care represents more than 50% of the total time with the patient) in a face-to-face encounter between the physician or the qualified NPP and the patient in the office/clinic or the floor time in the scenario of an inpatient service, the E&M code is selected based on the typical/average time associated with the code levels. The time approximation must meet or exceed the specific CPT code billed (determined by the typical/average time associated with the E&M code) and should not be “rounded” to the next higher level. Further, in E&M services in which the code level is selected based on time, you may only report prolonged services with the highest code level in that family of codes as the companion code.

Finally, you should remember that Medicare contractors will not pay (nor can you bill the patient ) for prolonged services codes 99358 and 99359, which do not require any direct patient face-to-face contact (e.g., telephone calls). These are Medicare covered services and payment is included in the payment for other billable services.
 
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