Otolaryngology Coding Alert

Question: A parent came in to discuss the care of his daughter, whom our allergist recently treated for anaphylactic shock (999.4) for a food allergy. (The parent is also a patient.) Our physician spent 30 minutes with the parent describing healthcare options, recovery time and diet restrictions. Although the child wasn't present, may I bill the visit?

Arizona Subscriber

Answer: The E/M codes include "face-to-face with the patient and/or the family." Most private payers, however, follow Medicare's policy and don't cover encounters in which the patient isn't present. Most insurers reimburse only for services that the physician delivers directly to the patient. Therefore, you should consider the visit a service to the patient who is in the office.

If the carrier will reimburse for the service, counseling comprises more than 50 percent, in this case 100 percent, of the visit. So, you should select the appropriate level of E/M service based on time. For a 30-minute established patient office visit, you should report 99214 (Office or other outpatient visit for the evaluation and management of an established patient ... physicians typically spend 25 minutes face-to-face with the patient and/or family).

For the diagnosis code, use either V61.49 (Health problems within family; other), which includes care of or presence of a sick person in the family or household, or V65.19 (Other person consulting on behalf of another person), which includes advice or treatment for a nonattending third party. If the payer does not reimburse for these codes, you can bill the patient.