Wiki E/M vs Consultation

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adooley

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I'm not sure what I should code if the patient comes in to just meet our physician. She spends about 15-20 minutes with them and discusses any issues but does not do an exam. The patient just mainly is wanting to meet the doctor to see if she wants to establish care. What should I code for this meeting?

Thanks!!
Angie :confused:
 
What code based on time? I don't know what we can bill without an exam. I have been billing for an ASC for 12 years so I'm just now getting back into physician billing and I need a little help. Thank you so much for taking time to answer me!

Angie
 
For E/M coding if the provider spends more than half the visit time with the patient in counseling or coordination of care and that is documented along with the time, you can code based on that. There is no exam needed when coding on time. My providers do a statement like this: "Greater than 50% of this face to face visit was spent in counseling or coordination of care. See note for issues discussed. Total time face to face:"

Then I pick my level based on:
99201-10 min
99202-20 min
99203-30 min
99204-45 min
99205-60 min

So for example is the provider said they spent 30 min in counseling or coordination of care you would code 99203.

I hope this helps.
 
In order to bill an E/M there must be medical necessity. Just coming in to meet the doctor does not establish medical necessity no matter how long he spends with the patient. Discussing issues without any medical decision making involved also does not establish medical necessity. In order to bill based on time at least 50% of the encounter must be spent in counseling and/or coordination of care. If your physician is not providing these two elements he cannot bill based on time.

Except for maybe an expectant mother meeting a pediatrician (and payment for that is rare) I don't know of any insurance company that will pay for a "meet & greet". You should check with your major carriers to see if they cover this type of visit and if they do how they want it coded.
 
documenting time

You medical record must state how long the patient was there and how long was spent doing counseling and what type of counseling was done.

Example: patient was seen in my office and a total of one hour was spent with the patient. 40 minutes were spent counseling the patient on birth control, hot flashes, hormone replacement therapy, night sweats, mood swings, and anxiety related to menopause.
 
If the patient has not established care with the physician and is only there to "meet" him/her to determine if she wants to establish care, then the question needs to be asked: What exactly is the provider counseling her about? If the doctor does in fact spend time counseling the patient, then he has established a relationship with her (also, sending a bill to the insurance company for this visit could be considered as establishing a doctor/patient relationship).

The biggest question in any encounter is Why is the patient here today? If it's not for a medical problem or preventive care, then it most likely is not billable.
 
dclark7 said:
If the patient has not established care with the physician and is only there to "meet" him/her to determine if she wants to establish care, then the question needs to be asked: What exactly is the provider counseling her about? If the doctor does in fact spend time counseling the patient, then he has established a relationship with her (also, sending a bill to the insurance company for this visit could be considered as establishing a doctor/patient relationship).

The biggest question in any encounter is Why is the patient here today? If it's not for a medical problem or preventive care, then it most likely is not billable.
Click to expand...

The initial post in this discussion mentioned that part of the visit was to "discuss issues." Of course, it depends on what "issues" - might not be a medical problem or preventative care as things that doctors are asked to do like sign school forms or back-to-work notes come to mind. If you can find the V code for it, you can BILL for it. But getting paid for it would be tricky....
 
The intial post also said the the patient "just mainly is wanting to meet the doctor to see if she wants to establish care". This to me, is the essence of a "meet and greet" encounter. I don't know of any doctor that would fill out forms or provide back to work notes for someone who is not an established patient. I also have not personally worked with any doctors who would provide medical advise during a "meet and greet" without examining the patient and going over family and personal history.

Just my opinion, but I don't think this type of visit is billable at all. If the provider feels he must get paid for these then he should establish a charge and let the patient know up front that she would be required to pay this out of pocket.
 
We have assumed custody of medical records of two physicians that retired. So most of these are former patients of that practice and were "referred" to us by that office.
Thank you all for your input.
 
You can only bill a "consult" (as opposed to "office visit") if your doctor is giving an opinion and sending the patient back to the referring physician for treatment or further consult. If your doctor "keeps" the patient, it is not a referral.

Medicare and many commercial carriers no longer pay for consults, though, anyway.
 
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