Wiki E&M visit without the patient present?

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jliving77

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We have a refugee patient whose mother came into the clinic for a visit that was scheduled for her daughter, however since it was to follow up on how her TB treatment is going she didn't think that the child had to come with her. I am copying exactly what he wrote as I don't want to miss something an not get an accurate answer to my question.

"CC: Mother is here for tb medication. She did not bring patient in with her..

History of Present Illness:
Translation phone service utilized for interview.

Mother here - she did not realize that was a scheduled appt. for her daughter so did not bring dtr from school.
Reviewed TB treatment course. Mother reports she started medication in Sept. as soon as it was prescribed. When asked to estimate how many days in total she missed a dose, she replies "zero" without hesitation - reports giving it to her every single day. Finished w/ medication in June. Reports that pt. has been in good health - no cough, fevers, sweats, weight loss.

Physical Examination
Height: 44 (09/20/2013)


Impression & Plan:
1. PPD POSITIVE.
Pt. has satisfactorily completed 9 mo. tx w/ isoniazid for latent TB. Educated mom that pt's TB skin test will remain positive, so she should not have this done in the future. Provided mother w/ letter documenting that pt. had neg. CXR and completed full tx course.

Pt. due for well child exam - mother taken to appt. desk w/ interpreter on phone to schedule appt. for this."

When reading this and checking the E&M section, 99212 requires a problem focused history; exam, and SF medical decision making. I think that it hits the mark for a problem focused hx and SF MDM and the definition goes on to say "typically 10 mins are spent face-to-face with the patient and/OR family".
Am I correct that I can bill this code due to it saying and/OR family?? Or is there a better code to bill for this visit? He did not document the time, does this have to be documented to bill this?
Jennifer CPC
 
help! need someone who has had this come up before!

The patient has AZ State Medicaid. I can't find any specific guidelines. Usually they follow CMS's rules on billing anything, with the exception of certain modifiers on some codes.
I am so confused. Has anyone else ever run into this problem? I would think that there would be patients who, for example, their mental status would not allow them to participate in their own visit and that the ROS and physical exam could be very limited due to the patient's willingness or comfortability for the provider to do so. I can see how the provider may spend more time obtaining information from the family and there has to be a way to bill for this.
:confused::(
Jennifer CPC
 
jliving77 said:
The patient has AZ State Medicaid. I can't find any specific guidelines. Usually they follow CMS's rules on billing anything, with the exception of certain modifiers on some codes.
I am so confused. Has anyone else ever run into this problem? I would think that there would be patients who, for example, their mental status would not allow them to participate in their own visit and that the ROS and physical exam could be very limited due to the patient's willingness or comfortability for the provider to do so. I can see how the provider may spend more time obtaining information from the family and there has to be a way to bill for this.
:confused::(
Jennifer CPC
Click to expand...


I've run into this a few times. Typically, Medicare, and any other government payer, requires the patient to be present in order for them to cover the visit. In this situation, my office notifies the family before the visit takes place that they will be responsible for the payment. However, some commercial payers will allow it--some of ours do. Contact a provider rep, and definitely get the answer in writing!!

Hope this helps!
 
Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 10 minutes face-to-face with the patient and/or family.

The normal E&M visit can't be coded without patient present's, because of the the code description states as "Typically spend 10 minutes face to face with the patient and / or family, this term indicates as the patient must be present in the encounter time if may be present or not the family member's so we can't code this level, please see the another set of CPT codes , Without direct ( face to face ) contact with the patient and / or family.

Parthasarathi P CPC
 
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