Wiki e/m code need

[veeramani14]

can anyone give me a solution for this case.

Only Pt's mom present. spend 40 min with the case. called the allergist who will see her and informed him of her problems. teenager not present. can we code it as 99215?

My Dr ask me this question. Tell me your inputs.


Thanks,
Veera

 

[marilynnj17]

Technically, in my opinion the answer lies with the payer. Private insurance allows the CPT definition to include patient or family member. Government programs such as Medicaid do not. For them the patient must be present. As to the code level, I doubt it, but it all depends on the documentation, and that alone. If it is documented to meet a level five, which I doubt due to lack of medical necessity and low level of severity, then it would be that level. Hope this helps.