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procedure code

  1. #1
    Question procedure code
    Medical Coding Books
    Is there a code that can be used to bill if a physician discusses a family members medical condition without the patient present?
    Andi M.

  2. #2
    Chicago South East Illinois Chapter
    Thumbs up Code For Discussion Without Face to Face with Pt.
    Hi Andi

    I don't know the particular's, but look in your cpt book Under Evaluaion and
    Management section. "Office or Outpatient Service". Look at cpt code 99201
    at the bottom of the description where the sentence starts out as "Usually"
    the presenting problem(s) are self limited to minor. Physicians typically spend 10 minutes face to face with the patient (here's the catch) and/or family.
    Meaning or family, that the patient was not present be careful because
    some of the codes say patient and/or family's needs. Choose the E/M codes
    that the physician had the discussion with the family only not the family's needs. There's also a few code choices under the E/M section Establised Patient. Let me know what you find.

    Dbryant, M.A., CPC

  3. #3
    Greeley, Colorado
    Thumbs down
    To the best of my knowledge, you CANNOT report an E/M code for discussing a patient with the family and the patient is not present. Without the presence of the patient, you do not have any way to meet the key elements of an E/M.

  4. #4
    Quote Originally Posted by andi View Post
    Is there a code that can be used to bill if a physician discusses a family members medical condition without the patient present?
    I was just skimming thru the cpt book and I don't see the codes anymore, unless I am overlooking it, maybe they got rid of those codes, but I know they "used to exist" I think the last time we used them was in 2004-2005.

    If my memory serves me correctly we did get paid from GHP that was the only insurance that paid for it.
    Last edited by rthames052006; 03-21-2008 at 11:04 AM. Reason: verified the info

  5. Default
    I would not use 99201 as you wont have the three key elements to obtain the level.
    I was thinking to use ICD-9-CM code V65.1, document time of counseling and base your level on amount of time counseling. I know time is not usually a determining factor, but from what has been given doesnt sound like a usual situation.

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