http://www.cms.hhs.gov/MLNProducts/downloads/eval_mgmt_serv_guide.pdf
Page 7-refer to the descriptions of each level (Eval and Mgmt Service Guide)
A Definition of New Patient for Selection of E/M Visit Code
Interpret the phrase “new patient” to mean a patient who has not received any professional services, i.e., E/M service
or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice (same physician specialty) within the previous 3 years. For example, if a professional component of a previous procedure is billed in a 3 year time period, e.g., a lab interpretation is billed and no E/M service or other face-to-face service with the patient is performed, then this patient remains a new patient for the initial visit. An interpretation of a diagnostic test, reading an x-ray or EKG etc., in the absence of an E/M service or other face-to-face service with the patient does not affect the designation of a new patient
http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf
http://www.aafp.org/fpm/20060600/coding.html
Counseling when the patient is not present
Q How should I bill for a family conference regarding end-of-life issues when the patient is not present?
Do you have a coding or documentation question?
A This depends on the payer.
CPT defines the counseling component of an E/M service as a discussion with a
patient and/or family concerning one of several areas described in the definition. One of the areas is prognosis, and another is risks and benefits of management options.
However, Medicare and some other payers require that E/M services include face-to-face services with the patient. Contact your payers to determine how best to bill for these services. If the patient's health plan won't reimburse you for the services, the family member's health plan might. If you bill the counseling service to the family member's insurer, consider using diagnosis code V61.49, "Other health problems within family," and an E/M code based on the documented time spent counseling.
