Orthopedic Coding Alert

Question: How can we bill for the time spent with the family discussing the patient?

Anonymous CA Subscriber

Answers: Whenever the visit consists of at least 50 percent counseling and/or coordination of care, the level of service may be chosen based on the entire time of the visit. For instance, when a history is taken, exam performed, and then a lengthy discussion ensues regarding treatment options, the physician would combine the time for all of those services and could then use that time to determine the level of service. For example, a total of 25 minutes would translate into a 99214. The documentation must list the time spent. As for discussion with the family, Medicare will not pay for office visit services unless the patient is present. Discussions in the office without the patient would be billable to the family but not to Medicare. Commercial carriers have varying requirements, so check with your top five carriers to clarify their interpretations on this issue.