Wiki Parent Dr. consult

[beesknees]

Im new to this and I have a Dr. who is trying to bill a for a consult with out the pt. being present. Mother had concerns with the child's behavior and came in to the office spoke with the Dr. he spent 20 min. talking with mom. How would I bill this? we are not referring provider

any help would be great

 

[CodingKing]

I know Medicare doesn't pay without patient present but I'm not sure about other insurances.

Also this is not a consult for billing purposes as it doesn't meet the 3R's test. There has to be a request for an opinion by a physician, The provider needs to render an opinion and send a written report of findings to the ordering physician.

 

[Cynthia Hughes]

Agree with CodingKing that this is not a consultation as there was not a request for advice or opinion from a source other than the patient/caregiver. Look instead to E/M codes appropriate to the site of service. CPT states, "For coding purposes, face-to-face time for these services is defined as only that time spent face-to-face with the patient and/or family." (CPT Assistant March 2013 directly states that from a coding perspective the patient does not have to be present when the service is counseling/coordination of care.) Medicare policy will not allow billing when the patient is not present but private payer policy will vary. When billing for services where the patient is not present, the record should still reflect a focus on patient management. If the main focus is on parent issues (eg, coping skills), the parent becomes the patient.