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Office Visit w/13 Yr Old's Mom-Can I bill

  1. #1
    Default Office Visit w/13 Yr Old's Mom-Can I bill
    Clearnace Sale
    One of my Docs saw the mother of a 13 year old patient that came into the office seeking information/advice on her child's condition. The patient was NOT with the Mother. Can I bill for this and if so what code would I use?? Any advice??

  2. #2
    Greenville, NC
    Default You can bill
    See the below thread that covers billing when patient not present:

    What you consider is that patient is not present (i.e., no physical exam, no review of systems (hands on), little to no medical decision making, etc.) so is 50% or more of the time spent on counseling? Yes, 50% or more - in fact 100% of time is spent on counseling and you choose the appropriate established E/M OV code based on time spent. I learned this from an expert. An expert in my mind as he has 20+ years coding experience, trains Medicare auditors on what to look for in an audit, consults with Medicare, has a published book specifically on what E/M code to choose, travelled the country teaching CPC bootcamp courses (I was one of the students) and a boatload of letters behind his name. So, I will defer to his word on this over those on this site that can't comprehend billing an OV for a patient that is not in the room (there are several on here that refuse to do it).

    I used to interpret contracts for a living in the telecomm industry and a lot of what I did was read between the lines - this is one of those cases in coding as there is no E/M that is defined as "patient not present" so we have to read between the lines of "50% or more time spent on counseling".

    Hope this helps,
    Hunter Smith, CPC

  3. Default
    Does Medicare pay if the patient is not present?

  4. Default
    I can't get into the thread you gave us. Is there a better link? Thanks.

  5. #5
    Milwaukee WI
    Default Multiple posts on this topic
    There are many posts on this topic ... check the E/M, Family Practice, Internal Medicine, Auditing, and Medicare forums and do a search there.

    Read the rules/regulations/guidelines for Counselling & Coordination of care.

    There must be a medically valid reason why the patient cannot be present, and the discussion MUST be about the patient's care (i.e. plan of care for patient) ... not about how mom is dealing with the issues.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  6. #6
    Quote Originally Posted by lschoen View Post
    I can't get into the thread you gave us. Is there a better link? Thanks.

    or just go up to the current thread and change the thread # to 27538...
    Heidi Thompson, CPC

  7. #7
    Greenville, NC
    Default Medicare paying

    Yes, medicare pays when patient not present. Actually, a Medicare patient may be the most likely scenario - patient in nursing home, homebound, etc. and family members caring for the patient need to discuss with provider plan of care, prognosis, etc. Medicare pays fraudulent claims everyday I'm sure, they don't know if the patient is in the building/seen or not. It is our job to ensure we don't submit fraudulent claims and bill within the guidelines and the guidelines do allow you to bill an E/M OV for patient not present. As stated previously in this feed, there should be a valid reason patient is not there and that should be clearly documented in the note by the provider.

    Hope this helps.
    Hunter Smith, CPC

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