Wiki E/M help please

[TLC]

One of our doctors had a patient pass away. Her son had an appt with the doctor re: questions about her death and a recent urgent care visit. He is also concerned about his father re: coping with the death of his wife. The son,mother and father are all are patients of our doctor. Can this be billed and how? CPT/DX help please. Thank you.

 

[jorzano55@gmail.com]

A level 99212 would be the code for the visit you really can't justify medical decision making. It does not meet criteria for family counseling as it was not psych care. There is probably a V code for diagnosis.

I have to say if the physician treated this family on a regular basis and were well known to the physian in good faith and as part of overall care the physian should not submit ANY charges in regards to this visit.

The reimbursement you would get if any would be so minimal and if you had to balance bill the family is it worth losing them from your practice? Remember just like happy patients refer patients unhappy patients cause twice as many patients to switch care.

I also caution how the insurance will deem the visit should they investigate the claim. Compliance laws and CMS guidelines would consider this fraud or abuse. Again is this worth the the few dollars you may be lucky to get?


I know all to well the state of healthcare and I would be the last person to say not charge or write off a charge. I work for a very large well known DC teaching hospital and my job is to work all outpatient Medicare claims. I look for ways to increase revenue and decrease denials everyday. I educate every clinic, nurses and MD on documentation required everyday. I am proud to say last year we recouped over 2 million dollars of lost revenue by working together.

Sometimes you just have to know that the time you extended and helping ease the pain of the family or just listening did more healing than anything else and you did the right thing and it will come back to you many more ways.

Good luck. Jo Anne