Oncology & Hematology Coding Alert

Question: Is it correct to bill an E/M visit for a family meeting despite the absence of the patient?

New York Subscriber

Answer: Medicare requires that the patient be present during this type of encounter for an E/M code to be assigned. The only exception to this requirement might occur if the time spent with the family was directly related to how the family is to care for the patient. Details on this can be found in the Medicare Carriers Manual (MCM), section 15501C, and in the Coverage Issues Manual (CIM), 35-14.

Some payers allow you to report this service using 99499 (Unlisted evaluation and management service) for family visits. Copies of notes taken during the meeting should be sent with the claim. Because policies differ, you should ask the payer in question how to bill these sessions.