Primary Care Coding Alert

Question: When a family physician sees one or more family members to discuss a patient's care without the patient present, should we charge for this? If so, what codes would we use?

Florida Subscriber

Answer: You should report the appropriate-level E/M service code (such as 99212-99215, Office or other outpatient visit for the evaluation and management of an established patient) based on time. Because counseling dominates the visit, you may use time as the key element.
 
You would bill the service to the patient. Link the CPT code to the V code for family counseling without patient.
 
Example: An FP spends 15 minutes discussing treatment options and behavior issues with parents of a patient who was recently diagnosed with attention deficit hyperactivity disorder (ADHD, 314.01). Because CPT indicates "physicians typically spend 15 minutes face-to-face with the patient and/or family" on a level-three established patient office visit, you should report 99213. For the ICD-9 code, assign V61.49 (Other family circumstances; health problems within family; other). 
 
Not all insurers will reimburse an E/M service that lacks a face-to-face patient-physician encounter. For instance, Medicare requires that the physician meet directly with the patient. Private payers may cover the service.
 
Solution: If you're billing the E/M service for a Medicare patient or other insurer that denies non-face-to-face E/M services, bill the patient for the encounter. Alternatively, you may consider the encounter as a service to the family member(s) who are meeting with the FP. After all, the FP is addressing their concerns. In this case, you could bill the family members' insurance, rather than the subject patient's insurance, accordingly.