Urology Coding Alert
Face-to-Face Is a Must for Medicare
Question: What is the best way to code for a "family consult" when the patient is not present (no face-to-face contact)? The patient is a nursing home patient whom our urologist saw in consultation, and the family wants to come in to meet the urologist and discuss the best care. Answers to Reader Questions and You Be the Coder contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook; and Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist, two-urogynecologist practice in Indianapolis.
South Carolina Subscriber
Answer: If this is a Medicare patient, you will not be able to charge for this consultation. Medicare only pays when the patient is present, and you won't find any way around this.
You can bill the family personally for their visit, or you can have the family present at the nursing home with the patient in the room when the urologist returns to discuss the treatment options. This would not be another "consultation" but rather a nursing home follow-up or subsequent visit (99307-99310).
Key: The important thing in this situation is that the physician has face-to-face contact with the patient along with discussing treatment options with the family, and he reports this visit as a medically necessary visit after an initial consultation.
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