Wiki family counseling without pt present

[tlwhlw]

We have a mostly geriatric population of patients. Sometimes the sons/daughters will request a couseling or consult time with the physician, without the patient present. I believe the correct way to code this would be E/M 99201 - 99215 codes. I don't think the counseling codes are correct, 99241 - 99245 per CPT quidelines. Here's an example of such a visit:

Type of Note: Addendum
Subject: FAMILY COUNSELING.
Additional Information: PATIENT'S SPOUSE AND SON WERE HERE THIS AM TO DISCUSS PATIENT'S STATUS, CARE IN PV SAMARITAN SNF, PROGNOSIS, LONG TERM CARE, PLANS TO MOVE TO PRIVATE CARE HOME, DECLINING WEIGHT, POOR APPETITE AND WEIGHT LOSS. CONCERNS WERE EXPRESSED REGARDING COMPLIANCE MEDS AT SNF, REDNESS OF EYES. COUNSELING TIME 30 MINS.


We are not billing this to Medicare, as it is definitely not payable by them. Does an ABN need to be signed? If there is anything in "black and white" that I could show to the doctors, that help would be greatly appreciated. This is one area that can be confusing as to how to bill correctly. Thank you!! Tracy, CPC

 

[dballard2004]

Per the CMS and CPT guidelines, if the provider spends greater than 50% of the visit counseling the patient or the patient's family, you can code the level based on time and report the appropriate Office/Outpatient E/M code (99201-99215).

NOTE: This does not apply to Medicare because they won't pay for non face to face services. I would get an ABN here anyway even though Medicare won't cover this. The patient is still financially responsible for Medicare non-covered services.