Wiki Telehealth with family member

[Ckrogers]

I have a doctor who performed a telehealth visit today. The patient was very ill with Covid and unable to participate. There was verbal consent received for the doctor to speak with and give advice to the patients daughter. We are wondering if this is a billable visit since the patient was not available but did agree to have the daughter speak and receive direction on his behalf?

 

[CBLENNIE]

If the patient's insurance is Medicare, it is not a billable as Medicare requires the patient to be present for the E&M. Commercial insurance companies have different policies so you'll need to check with this patient's specific insurance company, and you may want to contact all of the major insurance companies you submit claims to in order to determine who does or does not cover these services.

That said, there are tons of previous posts about billing for Telemedicine and in-person visits without the patient being present, although it is usually a parents attending visits on behalf of pediatric patients, but the premise remains the same.

Here are some past posts, including links to some of these posts:

• Telehealth (ignore the discussion of Medical Team conference codes 99366-99368, they didn't apply the thread linked here, nor do they apply to your scenario)
• Patient on phone, representative in office
• CPT for parent & physician consult
• Is telehealth billable without patient present
• Telehealth with a family member, not the patient

Good luck on your endeavors to find a straight answer to this question as nobody else has been able to do so for the commercial insurance companies. Nor has anyone found any consistent coding guidelines from various professional associations. If you find this info and share it you will likely be a hero to the many who have and continue to struggle with this question!

 

[medicalauditor]

If the patient's insurance is Medicare, it is not a billable as Medicare requires the patient to be present for the E&M. Commercial insurance companies have different policies so you'll need to check with this patient's specific insurance company, and you may want to contact all of the major insurance companies you submit claims to in order to determine who does or does not cover these services.

That said, there are tons of previous posts about billing for Telemedicine and in-person visits without the patient being present, although it is usually a parents attending visits on behalf of pediatric patients, but the premise remains the same.

Here are some past posts, including links to some of these posts:

• Telehealth (ignore the discussion of Medical Team conference codes 99366-99368, they didn't apply the thread linked here, nor do they apply to your scenario)
• Patient on phone, representative in office
• CPT for parent & physician consult
• Is telehealth billable without patient present
• Telehealth with a family member, not the patient

Good luck on your endeavors to find a straight answer to this question as nobody else has been able to do so for the commercial insurance companies. Nor has anyone found any consistent coding guidelines from various professional associations. If you find this info and share it you will likely be a hero to the many who have and continue to struggle with this question!

Can you please link a Medicare resource which states this? I have been trying, but unable to find one. Thanks in advance.