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billing based on time - without the pt present

  1. #1
    Default billing based on time - without the pt present
    Medical Coding Books
    One of our physicians counseled a patient's mother regarding the patient's care. (17 year old) She wants to check and see if this is billable:

    I had an appointment with a 17 YO girl but her mother was the only one to come to the appointment. I did spend at least 30min in discussion with the patient's mother, but of course could not examine the actual patient. what do I do with this from a billing perspective? Can I bill at all given that the patient was not even present for the discussion?

    I had one source tell me:

    "You can bill the mother directly using the counseling code without patient present. It is not covered by insurance."

    CPT states, under Time guidelines, Face-to-face time is defined as only that time that the physician spends face-to-face with the patient and/or family. So does the "and/or" mean we can still bill for the time spent counseling the mother about the daughter's care? Does the fact that the daughter was not present effect this?

  2. #2
    We follow CPT in these instances and bill the E/M since it says "patient and/or family" except for Medicare. Medicare doesn't cover these visits because they require a face-to-face with the patient.
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    National Advisory Board Member 2018-2021, Region 6 Great Lakes
    Minneapolis AAPC Chapter, Education Officer 2018
    AHIMA ICD-10-CM/PCS Trainer
    AAPC National ICD-10 Trainer

  3. #3
    This is billable per CPT, however it will not be paid by every payer - I agree with Pam.

  4. #4
    Thank you! The Pt has a commercial ins. so we are going to try billing the visit. I appreciate the input!

  5. #5
    Milwaukee WI
    Default Patient name
    You bill under the patient's name (in this case the 17 YO girl).
    Documentation should state:
    Total amount of time spent face-to-face with patient and/or family
    Amount of time spent in counseling/coordination of care (must be MORE THAN 50% of total)
    Nature of counseling/coordination of care
    Some statement as to why the patient was unavailable (this should be a medically necessary reason, not just "didn't want to skip school")

    Example: I spent 30 minutes with Mom today discussing Daughter's condition and treatment options; 100% of the time was for counseling/coordination of care. Due to the nature of the illness, Mother wished to discuss treatment options with me before meeting with her daughter.

    Code the appropriate level E/M based on the total amount of time spent.

    F Tessa Bartels, CPC, CEMC

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