Advanced Search

Otolaryngology Coding Alert

READER QUESTIONS:

Not All E/M Rules Require Patient Presence

Published on Tue Apr 10, 2007

Question: A patient's father came in to review test results without the child present. Should the otolaryngologist charge an E/M service? Is a patient exam a requirement of an E/M service?


Ohio Subscriber


Answer: When counseling and/or coordination of care dominates a visit, you may use time as the controlling factor in selecting an E/M code, according to CPT E/M Services Guidelines. Time-based coding trumps all typical E/M components of history, examination and medical decision-making. So your otolaryngologist may report an E/M service, such as an office visit (99212-99215, Office or other outpatient visit for the evaluation and management of an established patient -), without performing an exam.

Problem: Medicare requires a patient to be present to bill an E/M service. For visits without the patient present, you should charge the service to the family member or treat it as a courtesy. Private payers may not require patient presence.


You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

Otolaryngology Coding Alert

View All