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E/M without a face to face with patient

  1. #1
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    Default E/M without a face to face with patient
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    I am wondering if we could charge this out as an E/M?

    Pt was unable to come to appt. she is 10 years old. Mom came instead and Dr reviewed pts Catscans and bloodwork, and s/w mom about pts options for surgical intervention. Spent 30 minutes with Mom? But never physically seen the patient.
    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
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    Candice.Fenildo@appcca.org

    "Nothing is stronger than the heart of a volunteer"

  2. #2
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    ohh.. mom's not going to be happy about this - but no, you can't. It's going to have to be billed under the MOM's name (not the child). Probably won't be covered because it's going to be an E/M level with a "V-code" dx.
    Donna, CPC, CPC-H

  3. #3
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    I believe you can bill and E/M under the child. If you look at the CPT book and look at one of the established visit codes it states that it can be a family member. I am at home and do not have a CPT book in front of me but I am positive that they word it in such a way that the patient does not have to present for an established visit E/M code.
    Susie Corrado, CPC
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  4. #4
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    Donna, Someone else told me that as well. I just wanted to get more opinions. Not to sure on what V code to use, I'll have to do some research. Thank you for your imput
    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"

  5. #5
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    Quote Originally Posted by Candyr73 View Post
    I am wondering if we could charge this out as an E/M?

    Pt was unable to come to appt. she is 10 years old. Mom came instead and Dr reviewed pts Catscans and bloodwork, and s/w mom about pts options for surgical intervention. Spent 30 minutes with Mom? But never physically seen the patient.
    Candy...At the very least you should be able to do an Unlisted E/M Service 99499. This is clearly E/M for the childs condition and if you look thoroughly in your CPT book you will find something to use. The E/M Guidelines discuss the Unlisted Service and the Special Report that will need to be submitted with it. "An unlisted service or one that is unusual, variable, or new may require a special report demonstrating the medical appropriateness of the service. Pertinent information should include an adequate definition or description of the nature, extent and need for the ....service". As one of my teachers always said "Read your Guidelines".
    Donna, you should be careful before you answer.

  6. #6
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    I completely agree w/ jreiner. And to boot. No, you don't bill under the mother. The child is the pt, therefore you bill under the child.
    adrianne, cpc

  7. #7
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    Quote Originally Posted by scorrado View Post
    I believe you can bill and E/M under the child. If you look at the CPT book and look at one of the established visit codes it states that it can be a family member. I am at home and do not have a CPT book in front of me but I am positive that they word it in such a way that the patient does not have to present for an established visit E/M code.
    Suzie - I do see that. (thanks for pointing that back out to me). So, I could be wrong and you might be able to bill it under the child name, (but I'm still not convinced that's what the info under the est visit means) anyway -the code you'd be using is going to be a V-code, probably V65.1.
    It might different with parents on behalf of kids - I do know that at my other facility, for our elderly patients, we could not bill Medicare if the patient was present and family members were being seen on behalf of the patient.
    Last edited by dmaec; 07-23-2008 at 09:11 AM.
    Donna, CPC, CPC-H

  8. #8
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    Quote Originally Posted by jreiner View Post
    Candy...At the very least you should be able to do an Unlisted E/M Service 99499. This is clearly E/M for the childs condition and if you look thoroughly in your CPT book you will find something to use. The E/M Guidelines discuss the Unlisted Service and the Special Report that will need to be submitted with it. "An unlisted service or one that is unusual, variable, or new may require a special report demonstrating the medical appropriateness of the service. Pertinent information should include an adequate definition or description of the nature, extent and need for the ....service". As one of my teachers always said "Read your Guidelines".
    Donna, you should be careful before you answer.
    jreiner - yes, I should be more careful with my response - thankfully - our answers in these forums are "opnions", usually based on our own experience. Nothing written in stone, if you know what I mean! .. It's why we all get to respond, and opinions "very" which you can see in ALL the forum posts. We learn something knew everyday...we're reminded of things we may have forgotten when somebody else with a bit more knowledge in an area chimes in with their VERY welcomed and appreciated information. My answer was based on my experience. I can say, that at the other facility I worked at, we didn't/couldn't bill a patient for services rendered not to them. It appears I may be mistaken and this service can be billed under the childs name although I'm still not certain I'm wrong on this- it's still going to have a Vcode for the dx - who knows what insurance will do with that.

    Just reading on another forum, same issue - and oddly - same answer from another coder - seems she feels the patient needs to be present in order to charge and E/M visit also - guess it's worth checking into more if needed
    Last edited by dmaec; 07-23-2008 at 09:40 AM.
    Donna, CPC, CPC-H

  9. #9
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    Quote Originally Posted by Candyr73 View Post
    Donna, Someone else told me that as well. I just wanted to get more opinions. Not to sure on what V code to use, I'll have to do some research. Thank you for your imput

    Candyr - I'm going to research a bit more also I'm still not convinced, but I've been wrong before! I think the V code is going to have to be V65.1, what do you think about that code?
    Donna, CPC, CPC-H

  10. #10
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    I'm going to step up with my "opinion" and say that I would not code an E/M visit if the patient was not present. Even though CPT E/M guidelines do not specifically state "patient must be present" it is my opinion that E/M codes are to be reported when the patient is present. I think perhaps we all need a little more guidance from CPT on this. Interesting that this does not come up in the E/M specialty study guide...

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