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Doctor/Parent encounter without child present ?

  1. #11
    Duluth, Minnesota
    Medical Coding Books
    Quote Originally Posted by Lisa Curtis View Post
    I disagree. E/M codes are meant for the evaluation and management of a patient - meaning the patient must be present for the evaluation. Counseling and coordination of care can include discussion with parents or guardians regarding management, but if the patient is not present you are missing the evaluation piece. Time can be considered the controlling factor to qualify for a level of service, but the patient still must be present for an E/M to be reported. These codes are meant for patient encounters, not family encounters.

    Anyone else in the E/M community want to weigh in on this?

    Lisa Curtis, CPC, E/M
    Hey Lisa - I have this very same conversation going in another forum - I agree with you, I don't see how you can charge an E/M under the patients name if the patient isn't there...I know at my other facility we never could/never did. We would code and E/M visit under the person who was there, we used a V code (V65.1 or whatever), highly unlikely it was paid, it usually ended up to be "self-pay" visit. (but I'm not a biller so I didn't follow payment) I don't think the notation under the E/M's that state "and/or family" means "so if PATIENT NOT THERE and family is, you can bill patient". I don't know, I got scolded in the other forum for giving my opinion
    Donna, CPC, CPC-H

  2. #12
    Greeley, Colorado
    I guess since CPT doesn't specifically state in the E/M guidelines that the patient "must be present", it comes down to the individual coder interpretation. My interpretation is that the patient must be present for an E/M to be reported. My interpretation therefore is my opinion. I would not advise my providers to code an E/M if the patient is not present.

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