Wiki Wife sees doctor, what code to use?


Clewiston, FL
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I know this is not payable with the insurance companies but I would like to know if there is a code to be used when the wife of a patient comes in to speak to the doctor about the patient and his plan of treatment? I cant seem to find a code for this. Also do you bill the wife?
Technically E&M codes are for the patient however, there are limited clinical scenarios in which the E&M could be conducted to address family needs as a whole. Especially when the family caregiver needs to understand the course of treatment because the patient is unable to care for themself. The documentation however would have to be time based and documented appropriately to reflect discussion of plan of care and treatment options. Documentation should also include:

_____ minutes spent in face to face counseling with ______. Greater than 50% of that time was spent in face to face counseling.

I would also guide the physician to include a statement as to why the E&M was being conducted with the patient's wife. Such as "due to Mr. Jones limited cognitive function the plan of care and treatment options were discussed in their entirety with Mr. Jones wife, Mrs. Jenny Jones".

It is very important that there is a valid medical reason for conducting the visit with a family member exclusively. This would also be on the rare side and not becasue Mr. Jones is playing golf :)
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I have just found an article regarding this. You are right except Medicare doesnt allow it. I have always thought that the E/M codes were for the patient only. Thats what I was taught. Guess you learn something new every day.

Thank you
Precise documentation is required for compliance with this rare occasion. If you decide to share with your providers make sure they really understand what is required to pass an audit of this scenario. They sometimes take things and run wild with them so keep a tight hold on these instances.

You are most welcome :)
Who do you bill?

I understand that you will use an E/M code and also we need all the documentation to bill the E/M, but do you will bill under the wife? (the person that was face to face with the Dr.)