Wiki without direct fact to face with patient

[kathyle]

My doctor saw pt's family for 35 mins to discuss of pt condition. Is this service billable to medicare? What is to appropriated CPT to bill with? Please advise.

 

[teresabug]

if you review the code description for the E/M codes, they are billable with or without the patient present. The provider has to document "35 minutes were spent with the family discussing....."

 

[mhstrauss]

I agree that, per CPT description, an E/M service can be coded without the patient being present, if the provider documents based on time. However, Medicare will not pay for a visit in which the patient was not present. Some of the commercial payers we deal with will, but you'll have to check with yours and preferably get an answer in writing. My clinic has a policy in place to inform family members that come for appts without the patient prior to the appt, so that they can pay out of pocket IF the payer is one that will not allow the visit to be billed to insurance.

HTH!