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Thread: E/M with mom of an established patient

  1. #1
    Join Date
    Apr 2007
    Savannah, Georgia Chapter

    Default E/M with mom of an established patient

    AAPC: Back to School
    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
    Join Date
    Apr 2007
    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
    PMCC Licensed Instructor
    Kansas City, MO Chapter
    Member Development Officer 2016
    Harrisonville, MO Chapter President - 2013
    ICD-10 Education Coordinator- 2012
    Chapter President - 2011
    President Elect - 2010

  3. #3
    Join Date
    Apr 2007
    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

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