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Family meetings without the patient present
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Medicare does not permit a physician practice to bill for family meetings without the patient present.  The physician may not bill Medicare, nor may they bill the family member.  It is fairly common for the spouse or child of a patient to ask to see the physician to discuss the patient's care.  The meetings can be quite lengthy and involve a lot of physician time.  For Medicare, however, unless the patient is present, there is no payment for the service.

You may not bill the family with or without an ABN, because the service is considered bundled, not non-covered.

State Medicaid programs have different policies: check with them.

For commercial payers, ask them if they follow CPT® or Medicare guidelines in relation to this.

CPT® codes are defined, when using time to select the code, as "discussion with the patient and/or family." This means that for commercial payers, a physician could bill for discussion with the patient family within CPT® rules.  However, the correct diagnosis code would be V65.19, "Other person consulting on behalf of another person." Using that V code may result in a denial from the payer.  If the payer denies the service as "Incidental" or "bundled," and you have a contract with the payer, you can't bill the patient or family for the service.  If the denial is "non-covered" then you can typically bill the family member who requested the service.

If the patient is present for the meeting, then the service is reportable and reimburseable.  See the article on using time to select a code.

See the article about critical care, and what time with the family may and may not be included.

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  • Click Here to Comment, Clarify and Rate this Article

    PammieJ
    Wed, Nov/30/2011
    Actually...in some cases, you can
    70.1 - Consultations With a Beneficiary’s Family and Associates (Rev. 1, 10-03-03) CIM 35-14 In certain types of medical conditions, including when a patient is withdrawn and uncommunicative due to a mental disorder or comatose, the physician may contact relatives and close associates to secure background information to assist in diagnosis and treatment planning. When a physician contacts his patient’s relatives or associates for this purpose, expenses of such interviews are properly chargeable as physician’s services to the patient on whose behalf the information was secured. If the beneficiary is not an inpatient of a hospital, Part B reimbursement for such an interview is subject to the special limitation on payments for physicians’ services in connection with mental, psychoneurotic, and personality disorders. A physician may also have contacts with a patient’s family and associates for purposes other than securing background information. In some cases, the physician will provide counseling to members of the household. Family counseling services are covered only where the primary purpose of such counseling is the treatment of the patient’s condition. For example, two situations where family counseling services would be appropriate are as follows: (1) where there is a need to observe the patient’s interaction with family members; and/or (2) where there is a need to assess the capability of and assist the family members in aiding in the management of the patient. Counseling principally concerned with the effects of the patient’s condition on the individual being interviewed would not be reimbursable as part of the physician’s personal services to the patient. While to a limited degree, the counseling described in the second situation may be used to modify the behavior of the family members, such services nevertheless are covered because they relate primarily to the management of the patient’s problems and not to the treatment of the family member’s problems. Cross-references: The Medicare Benefit Policy Manual, Chapter 6, “Hospital Services Covered Under Part B,”§20. The Medicare Claims Processing Manual, Chapter 12, “Physician/Practitioner Billing,” §10. The Medicare General Information, Eligibility, and Entitlement Manual, Chapter 3, “Deductibles, Coinsurance Amounts, and Payment Limitations,” §30.

    efuhrmann
    Tue, Jun/09/2009
    CMS Reference
    Where can I find this in writing-that Medicare requires the meeting be face to face with the patient present?

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