Pediatric Coding Alert

Question: A parent came into our office without the patient to speak with one of our pediatricians about her child. This is an established patient of the office who has been having some eating disorder issues. The pediatrician and the parent met face-to-face and discussed the issues for 30 minutes. Again, the patient was not present and there is no examination of the patient. Would a consult code (such as 99242) be appropriate to bill to the insurer for this visit, or should we report 99214?

Tennessee Subscriber

Answer: You should report a code from the 99212-99215 series based on time spent counseling and coordinating the patient’s care. As the descriptor for these E/M codes says, the visits in this category can involve time “with the patient and/or family.” In your case, because the time threshold for 99214 is 25 minutes, that would be the appropriate code to report, assuming that the pediatrician appropriately documented the total time spent, the time spent counseling, and what was discussed.