AAPC - Back to school
Results 1 to 3 of 3

Thread: OV without patient present

  1. #1

    Arrow OV without patient present

    AAPC: Back to School
    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
    Join Date
    Apr 2007
    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. #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.

Similar Threads

  1. E/M visit WITHOUT patient present
    By stacymoch in forum E/M
    Replies: 0
    Last Post: 07-10-2014, 10:24 AM
  2. How to bill when patient is not present
    By 1073358 in forum E/M
    Replies: 10
    Last Post: 04-27-2010, 07:50 AM
  3. Patient not present
    By lacyblue in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 12-31-2009, 09:59 AM
  4. Patient Not Present
    By uksjmartin in forum E/M
    Replies: 2
    Last Post: 09-24-2009, 01:17 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.