The CPT definition of an E&M service specifically includes mention of the patient and/or family:"Physicians typically spend XX minutes face-to-face with the patient and/or family.
"When discussing how to use time to select a code in the introductory section for E&M services, the CPT manual says:"When counseling and/or coordination of care dominates (more than 50 percent) the physician/patient and/or family encounter…
"This implies that an E&M service may be provided to a family member on behalf of a patient.
Why might this be necessary? A parent may want to discuss a child’s care without the child being present. In this case, if the payer follows CPT rules, a physician could bill the encounter as a meeting with the parent. The physician would bill the service based on time, document the nature of the counseling, and describe the reason why the service did not include the patient.
For the
diagnosis code, in addition to the condition being treated or discussed, you should add V65.19: "Other person consulting on behalf of another person." Using the V code may result in a denial from the payer, but correctly informs the payer that the patient was not present at the visit.
If the payer denies the service as "incidental" or "bundled," and you have a contract with that payer, you can’t bill the patient or family for the service. If the reason for the denial is "noncovered" then you can typically bill the family member who requested the service.
Hope this helps.