Urology Coding Alert

Question: One of our physicians had an office visit with only the patient's family to discuss the patient's care options. Theatient was not present. I know there is no billable E/M service without the patient being present. My question is, is there anything that would be billable in this situation?

Florida Subscriber

Answer: You should not expect to bill for this type of service. It definitely should not be billed to Medicare, but you might have an instance of a private insurer that does not follow Medicare guidelines of a face-to-face requirement allowing you to charge an E/M code, but this is highly unlikely.

You could have charged a fee up front for the family to have a consultation with the doctor, but now that it is already done I would not bill after the fact. The fee should have been told to the family prior to the appointment and to be paid at time of service.

There is a psychotherapy code 90887 (Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient) that seems to potentially fit, but most insurers will not pay for 90887.

Most practices encourage the family to bring the patient for the discussion, if possible. If that is not possible, provide the service knowing you will not be reimbursed. It is not something that happens frequently, so consider it a good deed for the day. You can still submit 90887 for the visit to track that the service was provided.