If this is a Medicare patient, nothing.
Medicare requires the presence of the patient.
In the office and other outpatient setting, counseling and/or coordination of care must be provided in the presence of the patient if the time spent providing those services is used to determine the level of service reported. Face-to-face time refers to the time with the physician only. Counseling by other staff is not considered to be part of the face-to-face physician/patient encounter time. Therefore, the time spent by the other staff is not considered in selecting the appropriate level of service. The code used depends upon the physician service provided.
Below is a good article that goes into further detail...
Let’s start with Medicare. Medicare does not allow billing for family meetings without having the patient present. If I want to have a meeting with my mother’s doctor (without having her present) to discuss her diabetes care plan, the doctor cannot bill anyone for this service, even Medicare. Why? Because Medicare considers this part of the pre- and/or post-workup for an E&M service. In addition, this conference may not be billed even if there is an Advance Beneficiary Notice because it is considered a bundled service, not noncovered. This is a long-standing Medicare policy.
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