Consult

I have a pt who came in to consult with the doctor regarding her husband having a stroke and how to help her cope. How do I code that? Dr spent quite a bit of time with her. Would a 99242 be appropriate and what diagnosis would I use? Any advise would be appreciated. Her insurance is Medicare.

re: Consult

I would suggesting billing by time counseling /coordination of care. I hope your Doctor wrote down the time and that over 50% of the time spent with her was counseling regarding coping skills etc. V61.49 for diagnosis.

re: Consult

Medicare: "When counseling and/or coordination of care dominates (more than 50%) the outpatient/office face-to-face physician/patient encounter or the inpatient floor/unit time, time is the key or controlling factor in selecting the level of E&M service."

CPT: "When counseling and/or coordination of care dominates (more than 50%) the physician/patient and/or family encounter (face-to-face in the office or outpatient setting or floor/unit time in the hospital or NF), then time may be considered the key or controlling factor to qualify for a particular level of E&M service. This includes time spent with parties who have assumed responsibility for the care of the patient or decision making whether or not they are family members."

re: Consult

Consultation codes are not billable for medicare. Use office visit codes instead.

re: Consult

Wait a minute; who was the patient? Are you asking about billing in the husband's insurance or the wife's? For her it sounds like situational depression. you can't bill the husband's insurance if he is not present.

re: Consult

Signaturedoc is correct: if a Medicare patient the beneficiary must be present in order to bill.

There is an article in Codapedia and extensive forum discussions about this topic. Search "family" and you'll find discussions about visits without the patient present.