# Billing a visit when patient not in attendance



## christinalyons (Mar 24, 2010)

Does anyone out there have any ideas on this scenerio:
 A mom comes in and discusses her child's behavior and the doctor prescribes an ADD medication.  Can we bill for this service and if yes, how?

Thanks


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## rachell1976 (Mar 30, 2010)

I don't think so, but would love to know if someone thinks you can.

our common scenerio is a child coming to discuss their elderly parent's care w/ the Internal med physician without the patient present.


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## crystak2 (Mar 30, 2010)

There are ICD9 codes for this situation~Hope this helps a little..

V65.1 Person consulting on behalf of another person
Advice or treatment for nonattending third party
Excludes:
concern (normal) about sick person in family (V61.41-V61.49)

V61.20 Counseling for parent-child problem, unspecified
Concern about behavior of child
Parent-child conflict
Parent-child relationship problem


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## Walker22 (Mar 31, 2010)

There are at least 2 threads concerning this very issue. I don't have the time to find them for you right now, but search for them, they are there, and very lengthy in the details.


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## mitchellde (Mar 31, 2010)

99358-9 are the CPT codes for this encounter.  As of Jan 1 2010 99358 is no longer an add on code and is now billed as a stand alone service for just the type of encounter you have described.


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## SCanterbury (Apr 5, 2010)

Debra, 

Those are non-face-to-face codes. They are not appropriate when the MD provided a face-to-face service.

Per CPT, face-to-face time refers to time spent by the provider face-to-face with the patient AND/OR FAMILY. 

See the CPT Assistant I posted in the other thread about this.

That said, some payers, like Medicare, may still prefer that face-to-face codes be used only when the patient is present. Since the patient is a child, however, that shouldn't be an issue, though it's possible that the state Medicaid program may have some restriction that overrules CPT.

Seth Canterbury, CPC, ACS-EM


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## mitchellde (Apr 5, 2010)

The 99358-9 are non face to face with the patient not totally non face to face.  If the child is not present and the physician is discussing issues with the parent then this is a non face to face with the patient.


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## SCanterbury (Apr 15, 2010)

Debra, 

You make a good point that the face-to-face time described in the prolonged service codes only refers to time spent with the patient, and I won't go into a long discussion as to whether this could also apply to face-to-face time with the family.

The point is that the prolonged codes shouldn't have to come into play in the first place. The base problem-based E/M codes DO specifiy that the face-to-face service can be with the patient AND/OR family.

Here is the CPT Assistant I posted in the other thread:

_December 2004 page 19
Coding Consultation:Questions and Answers
Evaluation and Management, (Q&A)

Question
What is the appropriate code to report for a service in which the physician provides only counseling and/or coordination of care regarding symptoms or an established illness to the family without the patient being present? 

AMA Comment
From a CPT coding perspective, time may be considered the key or controlling factor when the physician provides counseling and/or coordination of care that dominates (more than 50%) the patient and/or family encounter. For time to be considered a key component, the physician must spend face-to- face time with the patient and/or family (without the patient) in the office or other outpatient setting. This would include time spent with parties who have responsibility for the care of the patient or decision-making regardless of whether they are family members (eg, foster parents, person acting in loco parentis, legal guardians). The key components of history, physical examination, and medical decisionmaking do not need to be provided or documented when counseling and/or coordination of care dominates. Typical times are included in each code descriptor to assist in selecting the most appropriate level of E/M service. _

So unless the payer in question disallows this CPT provision that the discussion can be between the doctor and family "without the patient" as the article puts it, then a normal E/M code can be billed. A V-code would be used to identify the fact that the person meeting with the doctor isn't the actual patient. 

Now if the discussion with the family member is really, really long and you have enough time to possibly bill a prolonged service code, then we would have to deal with the sticky situation caused by the fact that the "face-to-face" prolonged service code only mentions the patient and not the "patient and/or family" as is mentioned in the description of the base problem-based E/M codes. That is a whole different discussion.

Seth


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