Get Paid for Care When the Patient Isnt Present
Published on Sun Nov 01, 1998
The parents want to meet with the pediatrician to discuss their childs test results. The child isnt present at the consultation. How should this be billed?
This question comes from Marilyn Phelps, of Pediatric Associates of Bellevue, WA, and it is not an unusual one.
First of all, CPT Codes defines counseling as a discussion with a patient and/or family . . . So family is equal to the patient when it comes to billing based on time for counseling.
Some confusion may be occurring because HCFA has declared that Medicare will only pay for counseling when the patient is present. This is not a concern for pediatrics, however.
Nevertheless, the answer is in the gray zone, says A.D. Jacobson, MD, the medical director of Pediatric Associates of Phoenix, AZ. The problem is what carriers will pay for, however, not what is correct coding. Its debatable whether you can bill if the child isnt present, he says. A lot of it depends on your local carriers.
Jacobson recommends that you document how much time you spend talking to the parents, and also document whether the child is in the room.
I havent seen this be a problem with audits, says Jacobson, referring to the issue of billing when the child isnt actually present, but when the pediatrician is discussing the case with the parents.
The office visit codes99212 to 99215are the most appropriate to use, and base the level on time. For counseling and coordination of care, time is used as an overriding factor to justify the higher code, under CPT. It is important, however, when using time as a factor, to document the amount of time spent on the patients case and the nature of the service provided.
Counseling for ADHD
Jennifer Higgins, billing and insurance manager for Childrens Medical Center, a five pediatrician, one nurse practitioner practice in Martinsville, VA, says her practice isnt comfortable billing for services when the patient isnt present. The situation arises most often with ADHD, she says.
The child may not be in the room the whole time, Higgins reports. They may keep the child in the room for five to 10 minutes, she says. This way, the pediatrician can get an idea of how the child handles him or herself while the parent and doctor are talking. But, then they send the child out to the waiting room, says Higgins. Later, when the session is almost over, the child is brought back in.
The visit usually takes [...]
