Wiki E&M Consult with family member only

[bkudsk]

Our provider saw family member of an elderly patient. Patient was not present. He documented his time and that 100% was spent counseling family about patient's conditions, etc. Can we bill Medicare an E&M based on time spent?

 

[ajs]

Our provider saw family member of an elderly patient. Patient was not present. He documented his time and that 100% was spent counseling family about patient's conditions, etc. Can we bill Medicare an E&M based on time spent?

Not billable to Medicare. Must have some sort of face to face time with the patient present to qualify for Medicare billing.

 

[CrysLednum]

Here was a pretty thorough answer from ACP Internist on that question.

Q: May I bill Medicare for time I spend interacting with a family member or other caregiver who supports my patient?

A: Medicare rules make it possible for you to bill for the time you spend discussing issues related to the care of the patient with a family member or other caregiver. Medicare views a caregiver as someone who has responsibility to care for the patient and/or assist with decision-making. The limitations on billing for the time you spend training, educating and/or instructing the caregiver are:

The caregiver interaction must occur during an encounter with the patient for whom you provide a service that Medicare considers to be medically necessary;

• Providing guidance to the caregiver cannot be the sole reason for the encounter, even if the patient is present during the visit; and
• You must choose to select the level of evaluation and management (E/M) service you will bill to Medicare for the encounter involving the patient based on amount of time you spend with the patient and the caregiver.
  
  Brett Baker is Director of ACP Regulator and Insurer Affairs. E-mail your coding questions.
  
  Hope that also helps,