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How to bill when patient is not present

  1. #1
    Default How to bill when patient is not present
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    I had an office visit yesterday where the patient's mother and caregiver came for the appt but the patient did not. Patient is 60 something and on Medicare. He has a mental d/o and does not understand things, therefore they did not bring him to appt. The appt was to discuss a new cancer dx with the mother and caregiver and figure out where to go next.
    What is everyone's policy on billing different insurances when patient not present?

  2. #2
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    Quote Originally Posted by 1073358 View Post
    I had an office visit yesterday where the patient's mother and caregiver came for the appt but the patient did not. Patient is 60 something and on Medicare. He has a mental d/o and does not understand things, therefore they did not bring him to appt. The appt was to discuss a new cancer dx with the mother and caregiver and figure out where to go next.
    What is everyone's policy on billing different insurances when patient not present?
    In these cases what our office policy is to bill the family for the service, they are aware of this at the time the appointment is made, your not going to find many insurances who will pay for this type of service.

    A few years ago we found that 1 insurance pd for it and that was GHP... we've had no luck with it, so thats why we have this policy in place.

    Good luck,
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  3. #3
    Location
    Milwaukee WI
    Posts
    4,466
    Default Counselling & Coordination of Care
    Page 8 of CPT 2008 Professional Edition states: (emphasis added by me)
    "When counseling and/or cooridnation of care dominates (more than 50%) the physician/patient and/or family encounter (face-to-face time in the office or other outpatient setting...) then time may be considered the key or controlling factor to qualify for a particular level of E/M services. This includes time spent with parties who have assumed responsibility for the care of the patient or decision making ... The extent of counseling and/or coordination of care must be documented in the medical record."

    In the scenario you present, the patient is not mentally competent to understand and make medical decisions, so his mother / caregiver are the decision makers.

    The physician should document:
    TOTAL time spent in face-to-face contact w/ decision maker
    WHY patient unable to participate in decision making
    Time spent in counselling/coordination of care
    The extent of the counselling / coordination.

    As an example:
    I spent 30 minutes face-to-face with Mrs X. Mrs X is the medical decision maker for patient Y who has dementia and is unable to participate in his own medical decision making. 100% of this visit was spent in counselling/coordination of care, discussing recent cancer diagnosis of patient and treatment alternatives.

    This example could be billed as 99214.

    Documentation is key in billing counselling/coordination of care. I'm assuming that your office has paperwork appointing Mrs X as the legal/medical guardian for the patient.

    F Tessa Bartels, CPC EMA

  4. #4
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    i dont think you can bill medicare for that visit though. there has to be a face-to-face visit with the patient....if this is incorrect, someone speak up....
    Dawnelle Beall, CPC, CPMA, CPC-I
    Licensed AAPC PMCC Instructor
    AAPC ICD-10CM Certified Trainer
    Previous AAPC Local Chapter President & VP

  5. #5
    Default
    Quote Originally Posted by 1015378 View Post
    i dont think you can bill medicare for that visit though. there has to be a face-to-face visit with the patient....if this is incorrect, someone speak up....
    I agree. You can not bill Medicare. So in this case bill the patient's family?

  6. #6
    Default
    Quote Originally Posted by 1015378 View Post
    i dont think you can bill medicare for that visit though. there has to be a face-to-face visit with the patient....if this is incorrect, someone speak up....
    I completely agree with you...

    That is why our office came up with billng the family member for the service up front, no insurance involved...

    Maybe in the future your office could have the pt show up with the family and doctor can see pt, then have pt leave the room to discuss with family members prognosis, treatment etc.... just an opinion.
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  7. #7
    Default
    we recently had a similar situation. wife came in regarding husband who is in nursing home, unable to make decisions, with her aware at time of service we billed her insurance for a consult based on time spent using diagnosis discussed regarding husband. in this case it was humana gold choice but they paid and all she had to pay was her copay. hope this helps.

  8. Default Non-physician services patient not present
    How 'bout health education and advice to a caregiver pertaining to a patient who is not present. Service is being provided by an RN. How should i bill this out? 98960 specifies "face-to-face" with the patient so that won't work. I was looking at 96155 and am thinking that may be appropriate. What do you guys think?
    Last edited by ESORENSEN; 04-23-2010 at 03:17 PM.

  9. #9
    Location
    Columbia, MO
    Posts
    12,570
    Default
    As far as physician encounter when patient is not present what about 99358-9 prolonged non face to face. It is not add on any more and should cover this type of scenario.

    Debra A. Mitchell, MSPH, CPC-H

  10. #10
    Default
    Here is some information worth looking into. See this from the IOM # 100-03:

    http://www.cms.gov/Manuals/iom/itemd...tNumPerPage=10

    70.1 - Consultations With a Beneficiary's Family and Associates
    (Rev. 1, 10-03-03)
    CIM 35-14
    In certain types of medical conditions, including when a patient is withdrawn and uncommunicative due to a mental disorder or comatose, the physician may contact relatives and close associates to secure background information to assist in diagnosis and treatment planning. When a physician contacts his patient's relatives or associates for this purpose, expenses of such interviews are properly chargeable as physician's services to the patient on whose behalf the information was secured.
    Jenny Berkshire, CPC, CEMC, CGIC

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