General Surgery Coding Alert

Question: We have a 17-year-old patient who has requested that we not discuss her care with her parents. Is this legal, and does HIPAA address this?

Georgia Subscriber

Answer: The legality in these cases will depend on individual state law. In some states, minors can consent to treatment , but other states require parental consent for specific types of services. As long as you are within the law, you can keep the records confidential.

Caution: If the child is endangering himself or others, document and report it to the necessary authorities as prescribed by your state laws or licensing regulations.

If the child is not a danger to himself or others and you are legally permitted to maintain confidentiality, you can document “DO NOT COPY OR RELEASE TO PARENTS” in the paper chart, EMR, and/or EHR. In addition, some physicians keep such documentation separate from the main chart in a confidential folder.

HIPAA: “The Privacy Rule generally allows a parent to have access to the medical records about his or her child, as his or her minor child’s personal representative when such access is not inconsistent with State or other law,” explains HHS Office for Civil Rights (OCR) guidance.

As mentioned above, state law is the top reason in determining a minor’s right to keep medical records confidential and from parents. OCR lists two other reasons why this might occur: First, a court order might decide a minor patient’s treatment or appoint another representative for the minor, and second, “the parent agrees that the minor and the healthcare provider may have a confidential relationship.”

HIPAA also allows the provider to be involved in the confidentiality decision when the state is “silent” on parental access. “The licensed healthcare provider may exercise his or her professional judgment to the extent allowed by law to grant or deny parental access to the minor’s medical information,” OCR says.

Important: The Privacy Rule also takes domestic violence, neglect, and abuse into account in these situations. If it’s a clinician’s professional opinion that sharing a minor’s information with the parent will endanger the child’s life, then the healthcare provider can choose not to regard the parent as the minor’s personal representative.