Pediatric Coding Alert

Answer: Although CPT allows coding for visits without the patient present, your pediatrician must have treated the child previously to bill for the service. If the child is an established patient, you should report an established patient office visit (99212-99215) for visits with the "patient and/or family," in this case for parent-only counseling. Codes 99212-99215 require only two of the three key components of an E/M service: history and medical decision-making. Therefore, the patient does not need to be present for an examination to bill CPT 99212 -99215.

On the other hand, because a pediatrician must examine a new patient prior to billing for counseling, the new patient office visit codes (99201-99205) require all three elements: history, examination and medical decision-making. Thus, you should not bill a counseling session for a new patient unless the child is present.

In your situation, the child is presumably established with your practice. Consequently, you may bill 99212-99215 based on the time that your pediatrician spent counseling the parent. When counseling consumes more than 50 percent, or in your case 100 percent, of an office visit, the physician can use time as the key factor in selecting the appropriate level of E/M code.