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Neurology & Pain Management Coding Alert

READER QUESTIONS:

Flat Fee Might Be Best for Visit Without Patient

Published on Mon Oct 04, 2010

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. Is that correct? Wisconsin Subscriber Answer: Code 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. The Instructions for Use of the CPT Codebook directs coders to "Select the name of the procedure or service that accurately identifies the service performed. Do not select aCPT code that merely approximates the service provided." Check out this example of 96155 from the AMA. A 41-year-old male is diagnosed with pancreatic cancer. He is undergoing aggressive chemotherapy and radiation treatment, and his prognosis is guarded. The patient isn't in the end-stage disease process so he [...]
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