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Correct CPT code for visit w/o patient

  1. #1
    Default Correct CPT code for visit w/o patient
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    My provider saw the mother of a patient who was too sick to come into the office and the mother wanted the results of the labs and to discuss what the provider thought needed to be done from this stand point. The provider did not do a ROS or a exam. What would be the appropriate CPT code to bill? Thanks for your help as always.

  2. #2
    Columbia, MO
    Us e the ICD-9 V code for other person seeking consultation on behalf of the patient and the 99358 for non face to face prolonged time as long as documentation supports a minimum of 30 minutes spent by the physician

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Thank You for your response but the visit was 15 minutes. What then would be correct?

  4. #4
    Columbia, MO
    There is no way to code for that, you will have to write it off.

    Debra A. Mitchell, MSPH, CPC-H

  5. Default
    What about code 99213 that says "Physicians typically spend 15 minutes face-to-face with the patient AND/OR family"?

  6. #6
    Columbia, MO
    Possibly however it has always been my understanding that the patient had to be present, and the and/or family was there in the event the patient could not communicate. I have never used an offive visit level for when a patient is not there. I am curious as to how the payers would see this and who will pay the copay.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    Overland Park, KS
    I think you could base the E/M level on time if the provider spent greater than 50% of the visit counseling the mother. The guidelines state that the time concept applies to patients and/or family (the exception being Medicare where the patient has to be present).
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow

  8. #8
    we use the V code to explain the visit and an office visit code 99213 for 15 min. time spent. notes need to explain the visit in detail in case of audit.

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