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Visit based on time

  1. #1
    Default Visit based on time
    Exam Training Packages
    Does anyone have a reference on coding for a counseling visit with the parent only and the patient isn't present.

    In my ped coding manual we can code a time based visit for counseling or coordination of care with a parent or legal guardian without the patient present. But requires time statment with content of counseling etc...

    I don't find anything anywhere where we can bill for an E&M (not time based) for a visit without the patient present (counseling only.)

  2. #2
    Location
    Milwaukee WI
    Posts
    4,466
    Default I think you answered your own question
    I think you answered your own question ... requires time statment with content of counseling etc...

    You also have to have a medically valid reason why the patient cannot be present and/or participate in his/her plan of care.

    There is no other way to do this.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Default Based on Time
    I had known we could bill this by time. My question was I can't find any reference to bill as just an E&M, NOT BY TIME.

    Our compliance officer believes she read somewhere that you can. I don't believe we can only with a time and counseling statment.

    I wish she could remember where on earth she may have read this!!!

  4. #4
    Location
    Milwaukee WI
    Posts
    4,466
    Default Time vs Key elements
    There is NO requirement that you bill based on time if you have the three key elements recorded.
    HOWEVER - your scenario states that the patient is NOT present. The ONLY way you can bill this is by using time spent in counseling/coordination of care, because that is the only time that discussion with family can override the three key elements.

    If you are billing based on time, the documentation MUST include not only the total time, but also that portion that was for counseling/coordination of care (must be more than 50% of total), AND also a description of the counseling.

    When the physician sees a patient directly, you can code with either the three key elements or based on time spent in counseling/coordination of care. An experienced physician can perform and document a level 5 established patient visit in a few minutes.

    Hope that helps,

    F Tessa Bartels, CPC, CEMC
    Last edited by FTessaBartels; 05-23-2010 at 09:37 AM.

  5. Default
    Just guessing on what your Compliance Officer was thinking of but......I wonder if your CO is thinking of the Prolonged Care E&M codes. They are identified as perfomed with and without the patient. One of the few ways these codes would be valid in your scenario is if your physician saw the child/pedi for exam and eval and then met separately with only the parents. There are more guidelines for the use of these codes and time spent would still be a factor so check your book

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