# Doctor/Parent encounter without child present ?



## johnbouis (Jun 13, 2008)

Can an E&M code be charged for visit between the pediatrition and parents without the child present.   There is HPI update and counseling/coordination of care.   No exam but child is established.


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## Lisa Bledsoe (Jun 13, 2008)

The patient must be present to report an E/M code.


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## csterling (Jun 13, 2008)

If the provider is counseling the parents regarding the child, an E/M code is used for the time spent counseling. The child does not have to be present.


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## Lisa Bledsoe (Jun 13, 2008)

csterling - do you have guidelines to support this?  To my knowledge evaluation and management codes are only reportable if the patient is present.


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## csterling (Jun 13, 2008)

If you read the description in the CPT book on counseling and coordination of care, it reads "the patient and/or the patient's family".

Our providers have counseling sessions with parents who think their kids might have ADHD.  These sessions last anywhere from a half hour to an hour and the E/M code is driven by time.  The ICD9 code is V65.19 "person consulting on behalf of another person".  Also, check out the AAP website.


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## Lisa Bledsoe (Jun 17, 2008)

I disagree.  E/M codes are meant for the evaluation and management of a patient - meaning the patient must be present for the evaluation.  Counseling and coordination of care can include discussion with parents or guardians regarding management, but if the patient is not present you are missing the evaluation piece.  Time can be considered the _*controlling*_ factor to qualify for a level of service, but the patient still must be present for an E/M to be reported.  These codes are meant for *patient* encounters, not family encounters.  

Anyone else in the E/M community want to weigh in on this?

Lisa Curtis, CPC, E/M


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## csterling (Jun 17, 2008)

How does your practice code a visit when parents meet with a provider to discuss behavioral issues, school problems, ADHD or learning issues? 

These visits are an important part of pediatrics, take up a great deal of a provider's time, and do not fit the citeria for consults. As long as the provider documents the total time with family, the nature of the counseling, and the time spent counseling (time spent counseling must be more than 50% of total time), the appropriate E/M code is used.


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## EARREYGUE (Jun 17, 2008)

*What I found...*

I had this question to so I contacted the American Academy of Pediatrics and this is their response…
RESPONSE:
When a parent comes in regarding a patient that already has been born and they are looking for advice on how to handle the child's illness or behavior, you can report an E/M service 99201-99215 based on 100% counseling and bill it under the child's name not the parents. The notes from the visit will go in the child's chart and all that was discussed is directly related to the child and their medical care.  Your ICD-9 codes would be the primary diagnosis of the illness/behavior or concern and then you can add in ICD-9 code V65.19


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## Lisa Bledsoe (Jun 18, 2008)

Did the AAP specifically state that the child did not need to be present?  I still find that hard to swallow.  E/M codes are meant for patient encounters, which can include counseling with parents.  If what is being said here is true, that would change the entire dynamics of E/M coding.  

We have the child also come for the appointment, but the child doesn't necessarily stay in the room during counseling.  At least this way the doctor is able to evaluate and speak with the child to formulate an assessment and then discuss with the parents their concerns.


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## scorrado (Jun 19, 2008)

I do not work in Pediatrician's office but we have charged E/M's when we are speaking/seeing a family member re: a patient. Patient may be a parent who has dementia and son/daughter needs to speak with the doctor alone re: treatment. Patient is in a nursing home and it is too disruptive for the patient to be taken out of home unless absolutely necessary.  It doesnt happen very often but because the E/M descriptions specifically states face -to -face with the patient and/or family we charge an E/M. I think the description is very clear on that fact.


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## dmaec (Jul 23, 2008)

Lisa Curtis said:


> I disagree.  E/M codes are meant for the evaluation and management of a patient - meaning the patient must be present for the evaluation.  Counseling and coordination of care can include discussion with parents or guardians regarding management, but if the patient is not present you are missing the evaluation piece.  Time can be considered the _*controlling*_ factor to qualify for a level of service, but the patient still must be present for an E/M to be reported.  These codes are meant for *patient* encounters, not family encounters.
> 
> Anyone else in the E/M community want to weigh in on this?
> 
> Lisa Curtis, CPC, E/M



Hey Lisa - I have this very same conversation going in another forum - I agree with you, I don't see how you can charge an E/M under the patients name if the patient isn't there...I know at my other facility we never could/never did.  We would code and E/M visit under the person who was there, we used a V code (V65.1 or whatever), highly unlikely it was paid, it usually ended up to be "self-pay" visit. (but I'm not a biller so I didn't follow payment)  I don't think the notation under the E/M's that state "and/or family" means "so if PATIENT NOT THERE and family is, you can bill patient". I don't know,  I got scolded in the other forum for giving my opinion


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## Lisa Bledsoe (Jul 23, 2008)

I guess since CPT doesn't specifically state in the E/M guidelines that the patient "must be present", it comes down to the individual coder interpretation.  My interpretation is that the patient must be present for an E/M to be reported.  My interpretation therefore is my opinion.  I would not advise my providers to code an E/M if the patient is not present.   
Lisa


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