Debra,
You make a good point that the face-to-face time described in the prolonged service codes only refers to time spent with the patient, and I won't go into a long discussion as to whether this could also apply to face-to-face time with the family.
The point is that the prolonged codes shouldn't have to come into play in the first place. The base problem-based E/M codes DO specifiy that the face-to-face service can be with the patient AND/OR family.
Here is the CPT Assistant I posted in the other thread:
December 2004 page 19
Coding Consultation:Questions and Answers
Evaluation and Management, (Q&A)
Question
What is the appropriate code to report for a service in which the physician provides only counseling and/or coordination of care regarding symptoms or an established illness to the family without the patient being present?
AMA Comment
From a CPT coding perspective, time may be considered the key or controlling factor when the physician provides counseling and/or coordination of care that dominates (more than 50%) the patient and/or family encounter. For time to be considered a key component, the physician must spend face-to- face time with the patient and/or family (without the patient) in the office or other outpatient setting. This would include time spent with parties who have responsibility for the care of the patient or decision-making regardless of whether they are family members (eg, foster parents, person acting in loco parentis, legal guardians). The key components of history, physical examination, and medical decisionmaking do not need to be provided or documented when counseling and/or coordination of care dominates. Typical times are included in each code descriptor to assist in selecting the most appropriate level of E/M service.
So unless the payer in question disallows this CPT provision that the discussion can be between the doctor and family "without the patient" as the article puts it, then a normal E/M code can be billed. A V-code would be used to identify the fact that the person meeting with the doctor isn't the actual patient.
Now if the discussion with the family member is really, really long and you have enough time to possibly bill a prolonged service code, then we would have to deal with the sticky situation caused by the fact that the "face-to-face" prolonged service code only mentions the patient and not the "patient and/or family" as is mentioned in the description of the base problem-based E/M codes. That is a whole different discussion.
Seth
