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Thread: minor patient, not present

  1. #1

    Question minor patient, not present

    AAPC: Back to School
    I have a scenario that is new to me.

    We have been referred a surgical consult for a minor patient. The parent's want to come in and consult with the doctor - without the patient attending.

    Any suggestions on how this would be billed?
    ~Ursula, CPC~

  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default Is there a medical reason for the patient being absent

    Is there a medical reason the patient cannot be present? Is the patient in a coma? Have severe mental disabilities? Currently quarantined for infection control? Or perhaps the patient is VERY young (a neonate, or infant younger than 1 year)?

    If you have a legitimate medical reason why the minor cannot be present (not just that they don't want to take him out of school today), then you can code based on time spent for counseling/coordination of care. Your documentation MUST include ALL of the following elements:
    1) Total time spent with parents
    2) Amount of time spent in counseling/coordination of care (must be MORE than 50% of Total time)
    3) Summary of discussion
    4) REASON why patient is unable to participate in the medical decision making and the visit therefore is with parents only.

    If the parents just don't want the child present then they will be responsible for the consultation charge.

    Be aware that if the patient is covered by Medicaid or Medicare (even as secondary) the patient MUST be physically present for this to be a billable service.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3


    It helps a LOT. Thank you!!
    ~Ursula, CPC~

  4. #4


    In follow-up, it appears that there is absolutely no medical reason for the absence of the patient. The parents chose to schedule a time to come in and discuss the possible options with the doctor themselves, prior to scheduling the pre-op/surgery visits.

    Self-pay, it is!!

    Thanks again for your help!!
    ~Ursula, CPC~

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