can new office visit/consult be billed if there is no exam?

I have explained to the general surgeon I work for that I cannot code/bill for his "new office visits or consults" if no exam was performed. He states that I can. Here are some scenarios:
1) patient had regularly scheduled mammogram - something was seen on the mammogram and patient was referred to him for surgery for removal of the finding.
2) patient had routine colonoscopy and cancer was found - patient was referred to him for colon resection.
3) patient went to ER in pain - was found to have classic symptoms of gallbladder problems along with ejection fraction of 2. patient was referred to him for gallbladder removal.

He states that he does not do any exam because of the radiologic findings, bloodwork findings, etc. and that he does the surgery based on these findings.

I have also explained that he cannot bill all of these patient visits/consults (like 24 patients per week) based on time. Time has to be documented thoroughly along with what was discussed, etc., during that time. He doesn't document any of this.

Can anyone tell me if I am wrong, and also how I should be coding these??

Thanks!

can new office visit/consult be billed if there is no exam

This can be billed if time is the driving factor. E/M services have key components and then have contributing factors. He/She must document they spent xx amount of minutes where 50% of the time was spent counseling patient about the options, risks and benefits of treatment. It sounds like to me though, every office visit will be limited or a level II if he/she is not documenting that.

He/she cannot however document every visit this way. Some visits require "laying on of the hands". If he/she documents every visit like this they could raise eyebrows at his payers and subject the practice to an audit.

can new office visit/consult be billed if there is no exam?

This is my thinking also. HOWEVER....I can only bill a limited if the patient is an established patient, correct? I didn't think I could code a NEW patient without an exam?

Touching is therapeutic

I had a patient I had seen for diabetes, heart disease, high cholesterol for years and years. She is 85 yrs old. I see her every 3 months. On one visit I did not examine her but we addressed her meds, labs, etc. As I walked out she said "aren't you going to listen to my heart?" I was absolutely sure that her heart was beating and did not need to be auscultated. But to her it was a crucial part of the visit.
Now in this case, I am amazed a surgeon would not examine a woman's breast before a procedure to look for deformities, synchronous lesions, etc, or examine the abdomen prior to a surgery to look for hernias, etc.

can new office visit/consult be billed if there is no exam?

A new visit can be without an exam as well if time is the driver. Nothing in the CPT guidelines indicate otherwise. Under the guidelines it states the key components (Hx, Px and MDM) are used in selecting the level of service with the exception of the case were the visit is predominantly counsleing or coordination of care; irregardless of new or established status of patient.

Again, this should not be your practice of EVERY E/M. Obviously if a patient has a breast lump, abdominal pain generalized or someother vague symptomatology, the physician obviously does an exam of some sort; based on the clinical judgement of the physician.

p.s.

the "limited" status would only be if the time is within the parameters of the code. If you look at each E/M code, it will give you the amount of time "the physician typically spends with the patient and/or family"--again he MUST document his time in the note.

time and no exam

The physician may certainly use time, and many of these visits are appropriate for time. The visit is spent discussing the risks and benefits, the "what ifs." The physician must document the total face to face time, and the fact that more than 50% was in the discussion. If it were my radiological findings and breast lump, I'd infinitely prefer that the physician talked to me, rather than do an exam that wasn't needed. Having said that: what you or I prefer doesn't matter. It's what the physician feels is clinically relevant. Then, if the MD documents it, "I spent 40 minutes with the patient, over half spent in the discussion outlined above," use time for a new or established patient.

As long as the MD isn't billing for 24 hours a day, it's fine. The MD can bill all of them that way, as long as the schedule shows that it was reasonable. There is no prohibition about that.

If there is no time documented, and no exam, you should use 99499, the unlisted code. But, instead, educate the physician to use time.

It is incorrect to bill an established patient.