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Billing for genetics

  1. #1
    Location
    Evansville Indiana
    Posts
    451
    Default Billing for genetics
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    Scenario:
    Genetics physician sees the parents of a Medicaid child to determine the genetic link for child's problem. Physician billed Medicaid under the child's name for the consult. Any thoughts on this? My initial thought was that the parent's insurance should be billed, but I am not an expert on this area and I don't want to tell the physician incorrect information.

  2. #2
    Location
    Milwaukee WI
    Posts
    4,466
    Default The patient is the parent
    Medicaid, like Medicare, requires face-to-face contact with the patient. It sounds as if only the parent(s) were present. So the "patient" in this case would be the parents and their insurance carrier should be billed for the services.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Location
    Evansville Indiana
    Posts
    451
    Default genetics
    I assumed that the child was present but when re-reading the dictation you can't really tell. There was no exam performed on either the child(if he was even there) or parents, so even if they wanted to bill the parent's insurance it would not qualify for a level because there was no exam and they would have been new patients, and there was no documentation of time. After reading your response and re-looking at the dictation, I don't believe there is anything billable here. (The genetic counseling code is a non-physician code according to coding clinic) Any further thoughts would be appreciated.

  4. #4
    Location
    Milwaukee WI
    Posts
    4,466
    Default Consultation based on time?
    As it stands now, I agree, you have nothing billable. (And you should immediately correct your charge to Medicaid under the child's name ... give back the money if it's been paid.)

    If there was a request for a consult from the child's pediatrician, AND, if your physician documented the time spent (and that more than 50% of that time was spent in counseling/coordination of care), AND if your physician sent a written report back to the requesting physician ... then you may be able to bill a consultation based on time.

    I'd ask the physician to dictate an addendum regarding time spent.

    F Tessa Bartels, CPC, CEMC

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