Neurology & Pain Management Coding Alert

Question: Does CPT include a code we can use when the physician sees the patient's family in the hospital but does not have a face-to-face visit with the patient? The closest I find is 96155, but I-m not sure that's correct.

Maine Subscriber

Answer: You-re correct that 96155 (Health and behavior intervention, each 15 minutes, face-to-face; family [without the patient present]) might not be the most appropriate code if the reason for the visit doesn't fit the code's criteria.

Another option might be E/M code +99358 (Prolonged evaluation and management service), depending on the length of the visit. However, you can only report 99358 in conjunction with another service.

Carrier caution: Medicare won't reimburse for any visit unless it is face-to-face with the patient, but private payers have their own guidelines. If your payer doesn't recognize these visits, consider charging the patient a flat fee that's payable up-front.