Wiki Question - Dr wants to bill for an E/M 99212

[Bella Cullen]

Hi,
Dr wants to bill for an E/M 99212 on a pt where he reviewed x-rays, went over the upcoming surgery, reviewed hpi again, but the only thing is, patient is a minor and was not present, this was all reviewed w/ patients mother. Can I bill 99212 for this or is there anything else to bill or nothing at all. I don't think we can bill it at all, but dr wants to.
He says he thinks he should be able to bill something do to his time spent with the patients mother reviewing everything.
Any suggestions???
Thanks

 

[Lanie Christman]

Question

As I understand the Global Surgical Package guidelines-preop care is included in the surgical fee. This would include xrays and going over the surgical procedure itself. I would think that this visit would not be separately billable. Hope this helps.

 

[FTessaBartels]

Outside global period?

FIRST .. if the visit was within a couple of days of surgery, then it's global to the surgery.

If NOT ... AND, if the physician documented time spent in counseling/coordination of care, AND, if the reason for the patient being absent and unable to participate in medical decision making was documented ... THEN you can bill based on time spent in counseling/coordination of care.

BUT ... if the child was absent just because mom didn't want to pull him/her out of school, that's not a legitimate reason for not having the patient present.

If the child has a legitimate medical reason for not being able to participate in the medical decision making, then your documentation should include:
1) total time spent face to face w/ parent (decision maker)
2) Amount of that time that was spent in counseling/coordination of care (in this case 100%)
3) the substance of the counseling/ coordination of care (surgery planning, outlining risks and benefits, alternate plans, etc)
4) why patient was unable to participate in the medical decision making (example: patient with severe developmental delay, so met w/ Mother)

Good luck.

F Tessa Bartels, CPC, CEMC

 

[Bella Cullen]

I printed out both of your replies and I'm giving it to the Dr. Thanks alot for both of your replies. I hope it clearifies things for him. Oh, and this was on DOS 1/30/09 and sx was on DOS 2/12/09.
I appreciate it. Thanks again.