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Office Visit w/Family Member

  1. Default Office Visit w/Family Member
    Medical Coding Books
    Does anyone know if we can code and bill a 30 minute office visit with a family member of a current patient. The patient was not present at the office visit due to illness.

    Thank you in advance.

    James Carey

  2. #2
    Milwaukee WI
    Default Counseling/Coordination of Care
    CPT 2008 professional edition, page 8 states:
    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...) ... (emphasis added by FTB)

    So, yes you can code the E/M level based on counseling/coordination of care provided the physician documents:
    1) total time spent face to face w/ family
    2) amount of time spent in counseling / coordination of care (must be MORE than 50% of total time)
    3) nature of the counseling/coordination of care.

    ADDITIONALLY, if the patient cannot participate in the session, your documentation should state WHY the patient is not able to participate. (If the patient is home with a cold, I don't think this will be considered reasonable.)

    Whether you can bill this is much more complicated. I work in a pediatric setting, so the only time I have used this with a MediCare patient was a case where the patient was in the ICU in a coma and the "counseling" took place in the ICU's conference room. (In an inpatient setting, time spent "on the unit" is still considered face-to-face for most carriers.)

    I have applied this coding guideline, however, in cases of children with major physical anomalies or developmental delays, where parents come in to see the physician without the child present.

    F Tessa Bartels, CPC, CPC-E/M

  3. Default
    I agree with F Tessa Bartels.
    ~Amy, CPC, CPMA, CEMC~

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