Results 1 to 3 of 3

E/M with mom of an established patient

  1. #1
    Savannah, Georgia Chapter
    Default E/M with mom of an established patient
    Medical Coding Books
    We had a mother come in today to have get test results for her young daughter but the child was not present. The child is an established patient. Can we bill for this service if the results were given to her and explained by the physician?

  2. #2
    Kansas City, MO
    Unfortunately there is no clear cut answer in this (unless it was Medicare who says no...but it's probably not Medicare in your case). Some payers will pay, some won't.
    Linda Vargas, CPC, CPCO, CPMA, CPC-I, CEMC,CCC, AAPC Fellow
    PMCC Licensed Instructor
    2018 Chapter President, Kansas City, MO

  3. #3
    Baton Rouge
    The description in established E/M codes states "physicians typically spend X minutes face to face with the patient and/or family". This statement leads one to believe that a visit with the mother would be billable. However, it is probably best to check with the payer; as the previous replier stated, it probably isn't Medicare.

    We did have one instance here in my clinic where the parents came in; we were told by the payer prior to the visit (it was Humana, if I'm remembering right) that the claim would be paid. We were doubtful, but the insurance did pay it. So it is possible.

    Hope this helps!
    Meagan Strauss, CPC, CEMC
    Coding Coordinator
    The NeuroMedical Center
    Baton Rouge, LA

Similar Threads

  1. Replies: 10
    Last Post: 04-27-2017, 07:14 AM
  2. New Patient vs Established Patient Code
    By pvacanti in forum Billing/Reimbursement
    Replies: 4
    Last Post: 05-14-2014, 08:00 AM
  3. new patient vs established patient guidelines in a SNF-please help
    By CTRAVIS in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 03-27-2014, 08:46 AM
  4. Urgent care new patient vs established patient
    By ewheeler in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 01-12-2012, 12:53 PM
  5. Replies: 9
    Last Post: 04-27-2009, 02:27 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.