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Answer: The confirmatory consultation codes are not appropriate in this case because they apply only when the physician gives a second or third opinion on the necessity of a previously recommended medical treatment or surgical procedure. The doctor may be advising the patient about her mother, but if it is not to confirm the appropriateness of a previously recommended treatment, it is not a confirmatory consultation.
Although CPT states, "face-to-face with the patient and/or the family" in the E/M code descriptors, Medicare reimburse only for services delivered directly to the patient. The same is true for the majority of commercial and third-party payers. Therefore, since the Medicare recipient was not present during this visit and no E/M services were provided, the encounter is not billable to Medicare.
You should consider this visit a service to the patient who is in the office, i.e., the daughter. You can bill the visit as an E/M service (99212-99215) based on the time spent counseling. For the diagnosis code, use either V61.49 (health problems within family; other), which includes care of or presence of a sick person in the family or household, or V65.1 (person consulting on behalf of another person), which includes advice or treatment for a nonattending third party. If the payer does not reimburse for these codes, you can bill the patient. |
