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OV without patient present

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    When a family member comes in to discuss treatment management for a family member we understand that we may bill that under the patient. For example a caregiver comes in to discuss an Alzheimer's patient, a parent comes in to discuss an ill child. Can anyone point me to some regulations around this? The definition of the E&M CPTs are "spends xx minutes with the patient and/or family". Thank you! Susan Whittaker, CPC

  2. #2
    Milwaukee WI
    Default Patient not present
    If the patient cannot participate in medical decision making, then a visit with the designated decision maker can be billed using time in counseling/coordination of care rules. HOWEVER ... this should be a very rare occurence.

    Your documentation must include:
    1. total time spent face-to-face with "patient" (parents or family member)
    2. Amount of time spent in counseling/cooridnation of care (must be more than 50% of total time)
    3. Substance of the counseling/coordination
    4. if the patient is unable to participate you must state WHY the patient is unavailable (e.g. patient in coma, patient w/ Alzheimer's, infant is nonverbal)

    Given all that, it is still preferable to have the patient at least present even if that patient in unable to participate.

    Remember, this is a very rare occurence. In my eight years in pediatrics I've seen this used exactly THREE times. (And two of those were inpatients where the dicussion was held in a conference room at the hospital, while the child remained in his/her hospital room.)

    F Tessa Bartels, CPC, CEMC

  3. Thumbs up Thank you
    Thank you, Tessa. This was most helpful!
    Yes, this is a rare occurance but it does happen and it's nice to be able to bill it out.

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