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Two pts at one appt

  1. #1
    Default Two pts at one appt
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    Man and women at a fertility consult and the doctor spends 15 minutes with the male and 45 with the female during the hour consult. Can it be charged as two individual consults?

  2. #2
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    Quote Originally Posted by loricoder View Post
    Man and women at a fertility consult and the doctor spends 15 minutes with the male and 45 with the female during the hour consult. Can it be charged as two individual consults?
    I pulled this from AAFP:

    Group visits have been the subject of ongoing discussions by the CPT Editorial Panel. Until a specific CPT code is developed for group visits, if ever, the panel has recommended that physicians use E/M code 99499, "Unlisted evaluation and management service." However, physicians who conduct group visits say they successfully bill for them using E/M office-visit codes (e.g., 99212 or 99213) according to the level of care that is provided and documented for each patient. Physicians should check with their individual payers to confirm that the codes they submit for these services are reimbursable under the circumstances.

  3. #3
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    Milwaukee WI
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    4,466
    Default Counseling / coordination of care
    This isn't my area of expertise, so forgive me if I'm off base here ...
    Sounds as if this is a strictly "counseling" type of consultation?

    If the physician has documented the History/Exam/ MDM for each separately, then you can bill according to the bullet points for the appropriate level of service.

    If NOT, and the whole purpose of the visit is counseling/coordination of care ...then the doctor would bill based on total time spent, for each patient. In your example
    Man - 15 minutes (99201 if new patient, 99213 if established); and
    Woman - 45 minutes (99204 new patient; 99215 for established patient.
    You'd need to have two separately documented notes, and I would think you'd need two patient charts.

    Just my thoughts ...

    F Tessa Bartels, CPC, CPC-E/M

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