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Thread: parent visit only

  1. #1
    Join Date
    Apr 2007
    Location
    SALEM NH
    Posts
    283

    Exclamation parent visit only

    a mom came in alone to discuss her childs dx of autism and spent 1 hour with doctor. how should this be billed???

  2. #2

    Default

    The way that I understand this is that you would have to bill directly to the mother and it cannot be billed to insurance since the patient was not present during the visit. The primary dx would be v65.19, other person consulting on behalf of another person. That is how we do it in our office.
    Hope that helps

  3. #3

    Default

    If the patient is an established patient, I can't fathom why you wouldn't be able to code an office visit. You have the two of the three components which is what CPT requires. When a parent wants to discuss, for example, how the medication is working for the child, but s/he doesn't want patient present. The provider is able to obtain a history and make decisions regarding the child's care, all of which can be done independent of an examination. The diagnosis is whatever the patient is being medicated for.

    The only exception is when the parent just wants an overview of child's medical history and there are no decisions to be made -that's when we charge the parent.

  4. #4

    Default

    Per CPT you can code an E/M for face to face visit with the patient and/or family in the outpatient setting. In this case you would code based on time. Your coding is based on the fact that more than 50% of the visit was spent counseling the parent about the patient's care.

    In this situation the highest you can code would be 99215.

    Hope this helps.
    Barbara Haskins CPC

  5. #5
    Join Date
    Apr 2007
    Location
    ERIE, PA
    Posts
    44

    Default

    If our office, we do not see parents without the patient present in the office. They are permitted to have the wait in the waiting area. No pt equals no charge.

  6. #6
    Join Date
    Apr 2007
    Location
    Minneapolis
    Posts
    328

    Default

    We bill E/Ms without the patient present to all payers except Medicare, since that is in the description of the E/M code, "Physicians typically spend ___ face-to-face with the patient and/or family." We've queried payers here and they told us that was correct.
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I
    AHIMA Approved ICD-10-CM/PCS Trainer
    AAPC National ICD-10-CM Trainer

  7. #7
    Join Date
    Apr 2007
    Location
    Columbia, MO
    Posts
    12,071

    Default

    one of the examples give for the use of the 99358 was a child with ADHD where the physician meets witht e parents a day or two before the patient visit and maybe even after, the instruc is to bill the patient visit with a visit level and and the parent part as the 99358, by adding up all of the time spent (before and after) as long as you have a minimum of 30 min. The non-face-to-face does not have to be on the same day as the patient visit as long as the time frame is reasonable. Also the 99358 is add on and must be submitted with the patient visit level.
    Just one more suggestion.

    Debra A. Mitchell, MSPH, CPC-H

  8. #8
    Join Date
    Apr 2007
    Location
    SALEM NH
    Posts
    283

    Default

    Thank you all for your input. I appreciate the help. This is a really great association. Its nice to see coders helping other coders.

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