AAPC - Back to school
Results 1 to 5 of 5

Thread: procedure code

  1. #1
    Join Date
    Apr 2007

    Question procedure code

    AAPC: Back to School
    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
    Join Date
    Apr 2007
    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
    Join Date
    Apr 2007
    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
    Join Date
    Apr 2007
    York, Pa


    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. #5


    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.

Similar Threads

  1. denial ER claim billing an EM code and procedure code
    By kmg745511 in forum Emergency Department
    Replies: 2
    Last Post: 11-09-2014, 08:55 AM
  2. Unlisted code vs Open Procedure Code
    By christinnagle in forum Orthopaedics
    Replies: 1
    Last Post: 03-30-2011, 12:06 PM
  3. Need help with a procedure code
    By sharon cpc in forum OB/GYN
    Replies: 2
    Last Post: 02-18-2011, 10:31 AM
  4. Need help w/procedure code
    By mrolf in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 06-02-2010, 05:32 PM
  5. Help with procedure code
    By CC5657 in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 07-02-2008, 10:59 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.