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Please help! Second time posting this question...

  1. #31
    Default
    Exam Training Packages
    I couldn't agree more!!

  2. #32
    Default
    See this thread for a related discussion....

    http://www.aapc.com/memberarea/forum...ad.php?t=26678

  3. #33
    Location
    Greenville, NC
    Posts
    87
    Default My 2 cents
    I took a week long CPC coding boot camp sponsored by one of the large companies that do them around the country. I actually took it 1.5 times (got the flu in the middle of one and they let me retake full course at no additional charge). This very issue came up - counseling family members without patient being present and it created a heated discussion. Long story short, the instructors of both classes are very well versed, very well credentialed, many years of experience between them, one even has a book published specifically on E/M coding, and both agree - the way you bill for this is via the E/M codes for OV.

    Yes Herbie, OV E/M without patient present is billable. It created a bit of debate, albeit not as heated as it got here on one side, but as stated, reading the guidelines exclusively within the AMA CPT book, that is the correct thing to do. Whether or not it makes sense or not to bill a "patient visit without the patient present" is not the issue. Given circumstance "A" what do I bill is the issue. Given this circumstance, the applicable E/M OV is to be billed based on time spent as "greater than 50% of time spent on education and/or counseling" (as it was 100% of time spent since patient was not present to do a physical exam, take history, etc.).
    Cheers and Happy New Year!

  4. #34
    Default
    Quote Originally Posted by hsmith67 View Post
    I took a week long CPC coding boot camp sponsored by one of the large companies that do them around the country. I actually took it 1.5 times (got the flu in the middle of one and they let me retake full course at no additional charge). This very issue came up - counseling family members without patient being present and it created a heated discussion. Long story short, the instructors of both classes are very well versed, very well credentialed, many years of experience between them, one even has a book published specifically on E/M coding, and both agree - the way you bill for this is via the E/M codes for OV.

    Yes Herbie, OV E/M without patient present is billable. It created a bit of debate, albeit not as heated as it got here on one side, but as stated, reading the guidelines exclusively within the AMA CPT book, that is the correct thing to do. Whether or not it makes sense or not to bill a "patient visit without the patient present" is not the issue. Given circumstance "A" what do I bill is the issue. Given this circumstance, the applicable E/M OV is to be billed based on time spent as "greater than 50% of time spent on education and/or counseling" (as it was 100% of time spent since patient was not present to do a physical exam, take history, etc.).
    Cheers and Happy New Year!

    Well put! And thanks so much for the shared info!! Always good to hear another view.

  5. #35
    Wink Cpt assistant on this subject
    I just received the CPT ASSISTANT for 12/09 and one of the questions answered is, "When choosing a new or established outpatient E/M code, is it necessary to perform all three key components in order to qualify for reporting?"

    ANSWER: " As indicated in the descriptor language of the new and extablished outpatient E/M service codes 99201-99205, each of the three key components are required when reporting services rendered to new patients. However, only two of the three are required when services are provided to establishedpatients. As with most rules, there are exceptions. An example of an exception would be when patient-visits consist primarily of counseling or coordination of care. The E/M Services guidelines in the CPT codebook provides further information pertaining to the use of time in the selection of an appropriate level E/M service code."

    I thought it was pretty neat that I just saw this discussion today after reading the CPT assistant that addresses this issue and backs up what the majority is saying.

    Michele R. Hayes, CPC, CEMC. CGIC

  6. #36
    Default
    I'm still watching this thread closely. Thanks for everyone for giving their opinion. Keep them coming!
    Walker Bachman, CPC, CPPM

  7. Default
    I would not utilize that code as it is for a comprehensive visit with medical decision making of high complexity. Not knowing if the patient had an E&M complicates the answer. If the patient had an exam for the infusion by a physician or ancillary provider, NP or PA you should use the prolonged duration code which meets the most closely. I find the inappropriate use of level 5 claims those I most frequently find do not have adequate documentation to be paid.
    Hope this helps.
    Louise Cardillo, R.N. B.S. CPC, LNCC

  8. #38
    Default
    First let me say that I too love the forum and find it resourceful I do however, think we should all treat each other respectfully and when we disagree, do it nicely. We after all are professionals. Ok now for my stance, I would have no problem coding for the face to face time my doc spent with pt's family as per my interpetation of the guidelines this is allowed. I would however appreciate my doc meeting the time requirements in his documentation. I in no way see this as fradulent in fact, I see it as capturing revenue earned correctly and accurately. That is just my two cents on the issue. Everyone have a great day.

    Live is ever learning; keep an open mind.
    Mjones7

  9. #39
    Location
    Greeley, Colorado
    Posts
    2,045
    Exclamation 2010 CPT Changes Insiders View
    Hi All - FYI: 99358 and 99359 have had the add on status removed (although you can't use 99359 without 99358). The publication states "however, the guidelines specify that the prolonged service must relate to a service or patient in which direct face to face care has occurred or will occure, and relate to ongoing patient management".

    Hope this helps.
    I too was very disturbed at the heated/angry turn that the post took. We must respectfully disagree when we disagree, not become defense and attack one another.
    Lisa Bledsoe, CPC, CPMA

  10. #40
    Default
    I agree that in 2010 these codes are no longer add-on codes, but the original discussion was about a DOS that occured in 2009, so I was using the 2009 CPT book as my source. Furthermore, I believe that I was as respectful as possible (I even said "I respectfully disagree"), and tried to end the debate before it got out of hand, to no avail.
    Walker Bachman, CPC, CPPM

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