Wiki can we bill E/M code without patient attendence?

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banumathy

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Hello all,

I have received follow-up office visit document, patient not able to getup so father was came to doctor office to get the medication from doctor. Please advice can we bill office visit without patient present?


Banu-CPC.
 
Are you kidding?

I can't believe this Dr. is so desperate for a dollar that this would even be considered a chargable issue.
If this were my physician, I would quickly look for another one that had some common sense.
 
Hi All,

Thanks for your advice,

Initially we did not charge for this account, but our clien get back with us stating CPT description says patient and/or family so we would need to bill for this service. Kindly advice what is the correct meaning for below description.

"counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem and the patient and/or family needs".

Banu.CPC
 
What services are actually being provided for this patient? If its just picking up medication, that isn't a billable service according to all of my manuals. There must be other information you have that would help us understand the situation and why this would be something someone would thing a charge applies to.
 
An example of the phrase that you are referring to would be a patient that needs to go to a skilled nursing facility after surgery. The physician would coordinate care with that facility for the patient.

A father simply picking up medication for the patient, does not, in my opinion, fall under this.
 
Thank you all


In E&M subsq visit(99231-99233), provider done debridement of wound separately. and stating I spent totaly time 1hr 10 min face to face time including cleaning and dressing of wound.

99233-25
99356-25
11042

kindly see the above coding: My manager wants to code 99356 for this scenario.

But my understanding is, if we are coding debridement(11042) separately, so we should not use 99356, because dr states total time includes the surgery.

please clarify me
 
Prolonged Service

I am assuming this is a NEW scenario ... not the one where the dad picked up the medication for son. (In general, it is best to start a new thread with a new scenario.)

You are correct. You can not include time spent for separately coded procedures in the prolonged service time.

Code only basic E/M service and procedure.

F Tessa Bartels, CPC, CEMC
 
Last edited:
Review the E/M section guidelines - these require face-to-face time with the patient.
 
What does the documentation look like for the "service" to the father? If he is simply picking up medications, this would not be billable. And frankly if he spent an hour talking with the MD about the patient (without the patient there) it probably wouldn't be covered by most insurances. There are codes for counseling without the patient present; however it doesn't sound as though the documentation would support one of those.

You may want to look at the following code set:

99366
99367

However, I caution that the documentation MUST support these management codes and the example you gave doesn't.
Suzan
 
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