Wiki Pt not seen by provider. Can provider bill an E/M as of 2023?

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GraceDavis

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Hi everyone, I have a Profee question. Before 2023 if a provider did not see a pt face to face we could not bill an E/M code (99231-99233, 99221-99223). As of 2023 has this changed? I was told that a provider can now bill an E/M even when they haven't seen a pt because a source can no longer be found stating they cannot. Is there a current source that still supports a provider cannot bill an E/M when they haven't seen a pt? (I am not referring to 99358) Thank you!
 
For clinic it would be a provider billing 99214 without seeing the pt. They have a note but state they didn't see a pt, no one else saw the pt either. In the past we would tell the provider we cannot bill for a visit if the pt wasn't seen. I am wondering if the same goes for 2023 and if there is documentation I can bring back to my team stating this.
Thank you so much for helping me!
 
Medicare requires an encounter involving the patient. CPT guidelines are less stringent and it may be the patient's family and/or caregiver. In your scenario, it seems no one was involved? That cannot be a visit. If the patient did not request a visit, and a visit did not take place, I don't see how you could possibly bill even 99211 let alone 99214.

The encounter can be via telehealth (audio/video) or telephone (audio only), but the patient must be involved and consent.
 
csperoni said:
Medicare requires an encounter involving the patient. CPT guidelines are less stringent and it may be the patient's family and/or caregiver. In your scenario, it seems no one was involved? That cannot be a visit. If the patient did not request a visit, and a visit did not take place, I don't see how you could possibly bill even 99211 let alone 99214.

The encounter can be via telehealth (audio/video) or telephone (audio only), but the patient must be involved and consent.
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I completely agree with Christine.
 
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