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Thread: Family Consult coding Question

  1. #1

    Default Family Consult coding Question

    AAPC: Back to School
    If a doctor has a patient in the hospital and has set up a consultation with the patients family in her office(out of the hospital) and another immediate family member calls in on conference call... How can the Doctor bill this?

  2. #2


    I would use your established patient codes 99211-99215.. and probably bill based on time because I'm sure a majority of it is counseling.. so the provider would have to document time, and that more than half of the encounter was spent counseling/coordinating care and include the total number of minutes/hours, what have you. The description of these codes state "physicians typically spend XX minutes face-to-face with the patient and/or family" I wouldn't even attempt for the family member that phoned in... just my opinion.

  3. #3
    Join Date
    Apr 2007
    Milwaukee WI

    Default Why is patient unavailable?

    It's important that this counselling session be for the purpose of medical decision making with the desginated decision makers in the absence of the patient (who has a medically necessary reason for being absent ... e.g. dementia or on a ventilator in the ICU)

    So, in addition to AR's comments (all correct), I'd also include a statement as to why the patient is unavailabe and unable to participate in the medical decision making.

    It would have been better if the physician had scheduled this session for the hospital conference room. You might get a denial because POS doesn't match (patient is still an inpatient, yet you will be using established patient office code).

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  4. #4
    Join Date
    Apr 2007
    Kokomo, IN

    Default family consult

    I was also told that if the Dr. had already seen the patient that day or sees the patient later, he could add the counseling time with the family to the E/M visit for the patient. Dr. needs to document the time spent (as stated previously). Is this correct?

  5. #5
    Join Date
    Apr 2007
    Milwaukee WI

    Default Adding up the time

    If your place of service is all the same ... i.e. all in the hospital
    So you have an inpatient and you meet with the family at the bedside (or in the designated conference room on the unit, which is considered "bedside") ... then, yes, certainly you may add this time to the time you have spent in visiting with the patient to code either:

    1) total level of E/M based on total time spent if more than 50% was for counseling/coordination of care (e.g. 15 minutes at bedside + 30 minute conference = 45 minutes total for 99233)


    2) Whatever level of E/M is appropriate as per documentation, plus prolonged service (if the family meeting was 30 minutes or more).


    3) For a critically ill patient: you total the time spent with the patient and with the family to code 99291 (plus 99292 as appropriate, depending on total time).

    F Tessa Bartels, CPC, CEMC

  6. #6

    Default Family consult

    I know the code book says 'patient and/or family' , but Medicare cannot be billed unless the patient is present.

  7. #7


    Since when?

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