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Agent visit on behalf of patient

  1. #1
    Default Agent visit on behalf of patient
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    The following report came from the physician. I cannot find any CPT or HCPCS codes that apply to this situation. Are there any or is this something that cannot be billed?

    HISTORY: The patient is not here today but his friend and agent, who has power of attorney for all matters other than as a conservator is here to discuss his capacity to function, capability, and problems he has been having. The patient gave her power of attorney per document that she brings. However, when she went to the bank, they told her that he had to be considered incapable as per an attachment of the durable power of attorney form. It is the agent's understanding and my understanding that the patient would like his long-term friend to have these powers at this time without his being declared mentally incapable or physically incapable. Rather than doing any further work on this now, I think it would be good to have the agent explore this matter with the patient. He is now physically incapable of coming to the office and as such she does have the power of attorney per appendix A of the document. If necessary to have her talk with the lawyer, I will give her a note to that effect. However, this may not be necessary. In the purpose of saving time, I will look forward to further communications. The patient is now at Marin General Hospital and he is clearly incapable of carrying out any matters on his own behalf. I will provide them with whatever paperwork is necessary.

    The patient is not here but his agent is here for this dictation. I spent 16 minutes with the agent, of which the majority was administrative matters and discussion.

    Thanks for your help.

  2. Default
    You should be able to do an E/M and bill the patient (not the agent).

  3. #3
    Ok, so I should use the regular office visit code of 99213 then?

  4. #4
    Evansville Indiana
    Default agent
    Medicare and most carriers require a face to face with the patient. What insurance does the patient have?

  5. #5
    I believe it is medicare.

  6. #6
    Evansville Indiana
    Default agent
    Medicare requires a face to face with the patient to bill an office visit. I believe it is a non-billable service

  7. #7
    Ok, Thank you very much for your help.

  8. #8
    Default Reference

    This reference suggests that billing may be appropriate. Agreed, not for prolonged services or counseling as both with require (with a few exceptions) face-to-face time. Exceptions i've read referring to critical care. I'll look through my other references tomorrow.

    There must be circumstances where pts are unable to communicate with provider which require responsible party be informed and make decisions, i.e neonate or toddler with parent. Question is whether it is bundled? Immunization with counseling isn't counseling with child?

  9. #9
    Evansville Indiana
    Default Medicare
    This patient is Medicare. And medicare requires face to face for an e&m. The patient may not be able to communicate or participate, but they must be at least in the room.

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