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Need help!!!!!!! Billable or non-billable???????

  1. Exclamation Need help!!!!!!! Billable or non-billable???????
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    I desperately need help with a question one of my peds PAs asked me. She saw one of our est pt's with her mother for a well-child visit. The mother and the father are not together but the father is very involved. The father had an appt to meet with the PA (on a different day) to discuss the pt's well-child visit. The PA meet with him for 45 minutes. Also, the pt wasn't with her father. So, can I bill this visit with the father?? and if I can, what do I bill??

  2. #2
    Default Possible
    Look under the pediatric section for "counseling session with mom"

    It can be appropriate to bill based on face-to-face time with individuals responsible for decision making on a patient's behalf. As always medical necessity must be met and adequate documentation must be in place.

    One concern that is immediately apparent is whether the mother and the father are being provided same information on separate visits. If so, medical necessity for the second visit would not seem to have been met. Also, were there clinical findings as a result of the well child visit that warranted a discusion with the father?

  3. Default
    No, there were no clinical finding that warranted the visit with the father. The mother and father just don't get along and can't be in the same room with each other. So, the father appt to meet with the PA was already set up. The appt was just to disscuss the well-child visit. The PA wasn't going to bill the visit with the father because she thought it would've taken about 10 minutes to meet with him. Instead, it took 45 minutes and she feels she should bill for it.

  4. #4
    Default Understood
    If there is no medical necessity, then billing is not a feasible option. I understand that providers may be pulled into family issues, which (and not trying to be too presumptive) is where other office staff come in, to avoid or minimize situations such as these.

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