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Consulting on behalf of another - How to Bill?

  1. #1
    Location
    Lansing, Michigan
    Posts
    84
    Question Consulting on behalf of another - How to Bill?
    Medical Coding Books
    We have been discussing this and I need other opinions. I work at a primary care office and we sometimes have parents come in without the child to discuss the child's diagnoses. If there is documentation to support 2 of the 3 elements, i.e. history and MDM, can we bill the insurance for the visit? I look at it that if the patient was not present we cannot bill for the visit, but others are tossing around the idea that we can? The same question would be for senior patients whose children are consulting the provider in regards to their parent's health. I appreciate any comments. Thanks. And would you use the diagnoses of the "patient" or simply consult on behalf of another person.

  2. #2
    Location
    Milwaukee WI
    Posts
    4,466
    Default Counseling and Coordination of Care
    This has been addressed in several posts on this and other forums. Search for "counseling/coordination of care." Read the guidelines in CPT carefully regarding counseling/coordination of care (i.e. billing based on time)

    You need to document:
    1) the total time spent face-to-face with the patient and/or family
    2) the amount of the time in 1) that was spent in counseling/coordination of care (must be at over 50% of the total time in 1))
    3) The nature of the counseling/coordination of care
    AND - if the patient is not able to participate in decision making:
    4) WHY the patient is not able to participate in medical decision making.

    For example: I spent 25 minutes with Mr & Mrs Patient, discussing Johnny's upcoming surgery, risks, benefits and outcomes were explained in detail. The patient is a pre-verbal infant who is not able to participate in decision making. 100% of the visit was spent in counseling/coordination of care.

    You code the dx the patient has that is being discussed. You bill under the patient's name.

    NOTE: the reason the patient is not participating has to be medically necessary. Not wanting to pull Johnny away from football practice would not be a medically valid reason for the patient not being present.

    The level of service is determined by how much TOTAL time was spent with the "patient and/or family."

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. Default
    I agree with Tessa, there is an artice on aap.com titled, "How to code when the child is not present" that discusses this if you are interested.

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