# Code for Family Consult when patient is not present? Is it allowable?



## chantell5113 (Aug 28, 2013)

Is there a code for family consultation?
A family wants to come visit the doctor to discuss their parent.  They don't want to the patient to know, so this would not be a visit with the patient.

It seems that there is one, I'm not sure what it is, and if the patient's insurance is going to be billed, they will find out about it!

The doctor is not going to do it without being compensated. 

Stuck!
Thanks!


----------



## gkaufman (Aug 28, 2013)

The E/M codes and Consult codes all include the statement, "face-to-face with the patient and/or family".  You would use the appropriate code for commercial and Medicare.  Hope this helps.


----------



## mhstrauss (Aug 28, 2013)

gkaufman said:


> The E/M codes and Consult codes all include the statement, "face-to-face with the patient and/or family".  You would use the appropriate code for commercial and Medicare.  Hope this helps.



I do agree that the E/M code description includes "face-to-face with patient and/or family"; however you need to check with the payers to make sure they follow the same guidelines.  Medicare will not allow for a visit that the patient is not present for.  We have gotten guidance in writing from several of our commercial payers that they will allow it.  If the payer won't pay this, the family needs to be informed up front and required to pay.

The other thing to keep in mind...do they have power of attorney or anything like that? You said that the patient is not aware of the appointment...if your office doesn't have written authorization from the patient to discuss his case with family, you may be in HIPAA violation.

Hope this helps!


----------



## chantell5113 (Aug 28, 2013)

Thank you!  This is very helpful.
Yes, without the OIHC or POA, we can't do anything!


----------



## npricercm (Aug 29, 2013)

chantell5113 said:


> Is there a code for family consultation?
> A family wants to come visit the doctor to discuss their parent.  They don't want to the patient to know, so this would not be a visit with the patient.
> 
> It seems that there is one, I'm not sure what it is, and if the patient's insurance is going to be billed, they will find out about it!
> ...



Novitas says no.  The patient has to be there.

https://www.novitas-solutions.com/faq/partb/pet/lpet-evaluation_management_services.html#6

The March 2013 CPT Assistant Professional Edition, (page 8), states that providers may bill an office/outpatient Evaluation and Management (E&M) visit (99211-99215) for meeting with a patient's family, to discuss the patient's care, without the patient present. Is this appropriate billing under the Medicare program?

No, billing office/outpatient E&M services (99211-99215), in the absence of the patient, is not billable under the Medicare program. Please refer to Internet Only Manual Publication 100-02, Chapter 15 §30(A) * and Claims Processing Manual, Publication 100-04, Chapter 12, §30.6.1 *.
Date Posted: 04/30/2013, Date Revised: 07/15/2013


----------

