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Doctor/Parent encounter without child present ?

  1. Question Doctor/Parent encounter without child present ?
    Medical Coding Books
    Can an E&M code be charged for visit between the pediatrition and parents without the child present. There is HPI update and counseling/coordination of care. No exam but child is established.

  2. #2
    Greeley, Colorado
    The patient must be present to report an E/M code.

  3. #3
    If the provider is counseling the parents regarding the child, an E/M code is used for the time spent counseling. The child does not have to be present.
    Last edited by csterling; 06-13-2008 at 02:01 PM.

  4. #4
    Greeley, Colorado
    csterling - do you have guidelines to support this? To my knowledge evaluation and management codes are only reportable if the patient is present.

  5. #5
    If you read the description in the CPT book on counseling and coordination of care, it reads "the patient and/or the patient's family".

    Our providers have counseling sessions with parents who think their kids might have ADHD. These sessions last anywhere from a half hour to an hour and the E/M code is driven by time. The ICD9 code is V65.19 "person consulting on behalf of another person". Also, check out the AAP website.
    Last edited by csterling; 06-14-2008 at 06:12 AM.

  6. #6
    Greeley, Colorado
    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

  7. #7
    How does your practice code a visit when parents meet with a provider to discuss behavioral issues, school problems, ADHD or learning issues?

    These visits are an important part of pediatrics, take up a great deal of a provider's time, and do not fit the citeria for consults. As long as the provider documents the total time with family, the nature of the counseling, and the time spent counseling (time spent counseling must be more than 50% of total time), the appropriate E/M code is used.

  8. #8
    Smile What I found...
    I had this question to so I contacted the American Academy of Pediatrics and this is their response…
    When a parent comes in regarding a patient that already has been born and they are looking for advice on how to handle the child's illness or behavior, you can report an E/M service 99201-99215 based on 100% counseling and bill it under the child's name not the parents. The notes from the visit will go in the child's chart and all that was discussed is directly related to the child and their medical care. Your ICD-9 codes would be the primary diagnosis of the illness/behavior or concern and then you can add in ICD-9 code V65.19

  9. #9
    Greeley, Colorado
    Did the AAP specifically state that the child did not need to be present? I still find that hard to swallow. E/M codes are meant for patient encounters, which can include counseling with parents. If what is being said here is true, that would change the entire dynamics of E/M coding.

    We have the child also come for the appointment, but the child doesn't necessarily stay in the room during counseling. At least this way the doctor is able to evaluate and speak with the child to formulate an assessment and then discuss with the parents their concerns.

  10. #10
    I do not work in Pediatrician's office but we have charged E/M's when we are speaking/seeing a family member re: a patient. Patient may be a parent who has dementia and son/daughter needs to speak with the doctor alone re: treatment. Patient is in a nursing home and it is too disruptive for the patient to be taken out of home unless absolutely necessary. It doesnt happen very often but because the E/M descriptions specifically states face -to -face with the patient and/or family we charge an E/M. I think the description is very clear on that fact.
    Susie Corrado, CPC
    ENT Coding/Billing

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