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E/M without a face to face with patient

  1. #11
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    Stuart Sailfish Chapter
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    Wow. thank you all for your "opinions". and yes that Dx code works. I think we are just going to EAT this one until I can get a definitive resolution.
    Candice Fenildo, CPC, CPMA, CPC-I, CPB, CENTC, CRHC, AAPC Fellow
    AAPC Chapter Association Board of Directors ( Chair)
    Region 6, Wisconsin, Minnesota, Illinois, Indiana, Michigan, Ohio
    772-342-6976
    Candice.Fenildo@appcca.org

    "Nothing is stronger than the heart of a volunteer"

  2. #12
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    Wow - I would be interested to see what CPT says as well. We have this occur in our practice quite often. We normally bill under the person who is here with V codes for dx. Now I want to know if it's right!

  3. #13
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    Duluth, Minnesota
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    I agree with Lisa - (and yes, more guidance would be great!)
    and, same here LEE ANN - that's they we've done it for years now!
    Donna, CPC, CPC-H

  4. #14
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    Reading in the CPT book it does state "For coding purposes, face-to-face time for these services (Talking about E&M) is defined as only that time that the physician spends face-to-face with the patient and/or family. This includes the time in which the physician performs such tasks as obtaining a history, performing an examination, and counseling the patient."
    Herbie W Lorona Jr., CPC, CPC-H
    hlorona@up2parmedicalclinic.com

  5. #15
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    Duluth, Minnesota
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    **this just in** Well, from I meeting I just attended ....
    for E/M charges counseling & coordination of care:
    Although CPT states "patient and/or family", CMS requires patient to be present.

    this info can be found on the CMS website

    Soooo, Lisa - LEE ANN - we're doing ok!
    Donna, CPC, CPC-H

  6. #16
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    I agree with that. It only makes sense to have the patient there!!!
    Herbie W Lorona Jr., CPC, CPC-H
    hlorona@up2parmedicalclinic.com

  7. #17
    Location
    Westin, FL
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    Donna...No offense meant, but the answer was stated as a fact not as an opinion. Sorry if your feelings were hurt.

  8. #18
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    Greeley, Colorado
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    Quote Originally Posted by dmaec View Post
    **this just in** Well, from I meeting I just attended ....
    for E/M charges counseling & coordination of care:
    Although CPT states "patient and/or family", CMS requires patient to be present.

    this info can be found on the CMS website

    Soooo, Lisa - LEE ANN - we're doing ok!

  9. #19
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    Duluth, Minnesota
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    Quote Originally Posted by jreiner View Post
    Donna...No offense meant, but the answer was stated as a fact not as an opinion. Sorry if your feelings were hurt.
    jreiner - none taken! but I don't know why there would have been anyways! no feelings were hurt...quite the contrary - I value others opinions (or facts if that what you wish). I make a conscious effort to learn from my mistakes (and I do make mistakes!), and to learn from others. I simply researched a bit more on this issue, found that I'm ok in the way we've been handling these circumstances and shared the information with everyone who responded to the original post. I will say however, that I stay far and clear away from unlisted procedure codes - never have used them for any E/M - have used them on some surgery procedures and of course have the documentation to back it up. I might add also that using the unlisted E/M code might be ok, I feel using the V-code on an E/M code under the person who is actually talking to the provider is more appropriate because there "is" an E/M visit and there "is" a dx for it. Either way, (yours or mine) chances are it won't be paid by insurance and will end up "self-pay" office visits. What is the charge for a 99499? (I ask, because I have no idea)
    Donna, CPC, CPC-H

  10. #20
    Location
    St. Cloud, MN
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    75
    Default Patient not Present - billing based on time
    My opinion comes from the CPT manual under the Evaluation and Management (E/M) Services Guidelines very last page.

    I know Medicare has a policy that they will not pay for a visit if the patient is not present – but CPT states when billing an E/M service based on time:

    “When counseling and/or coordination of care dominates (more than 50%) the physician/patient and/or family encounter (face-to-face time in the office or other outpatient setting or floor/unit time in the hospital or nursing facility), then time may be considered the key or controlling factor to qualify for a particular level of E/M services. This includes time spent with parties who have assumed responsibility for the care of the patient or decision making whether or not they are family members (eg, foster parents, person acting in loco parentis, legal guardian). The extent of counseling and/or coordination of care must be documented in the medical record.”

    Claim would be submitted under the child. Naturally all appropriate documentation for billing based on time must be in the medical record.

    Also in the description for CPT codes 99201-99215 reads such as on 99213 "Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 15 minutes face-to-face with the patient and/or family.

    Some payers may have a policy such as Medicare when patient is not present.

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