
Family meetings without the patient present
December 29th, 2015 - Codapedia Editor
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.
###
Questions, comments?
If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.
Latest articles: (any category)
Reporting Drug Wastage with Modifier JW and NEW Modifier JZAugust 15th, 2023 - Aimee WilcoxModifier JW has been around since 2003 with changes in Medicare policies to ensure standard utilization in 2017; however, because of a continued lack of reporting consistency, Medicare has created and implemented policy related to reporting a new modifier, JZ. How does this impact Medicare reimbursement and why is this modifier so important?
Finding Patterns of Complexity in the Medical Decision Making (MDM) Table August 8th, 2023 - Aimee WilcoxChanges to the Medical Decision Making (MDM) Table in 2023 reflect the work performed in the facility setting in addition to the work involved in Evaluation and Management (E/M) scoring in other places of service. Taking the time to really look closely at the MDM Table and identify patterns in wording and scoring helps coders to understand scoring in an easier way.
Seven Reasons to Standardize Medical RecordsJuly 18th, 2023 - Aimee WilcoxThe standardization of medical records offers numerous benefits for healthcare systems, providers, and patients. By ensuring interoperability, improved workflows, better patient safety, supporting research endeavors, and optimizing resource allocation, standardized records contribute to improved efficiency, quality of care and especially patient outcomes. Here are seven reasons to standardize medical records.
Advancements in Coding Hospital Observation Care Services in 2023July 4th, 2023 - Aimee WilcoxHospitals are increasingly adopting innovative solutions to improve patient care and optimize processes and many of these solutions follow immediately the recent CPT and Medicare coding changes. In 2023 coding of hospital observation care services underwent significant changes enabling healthcare providers to accurately document and bill for the sick or injured patient that requires a higher level of medical services between the emergency room care and hospital admission. This article explores the key changes in coding hospital observation care services and their impact on healthcare delivery.
Be Aware — Emergency Department Visits Under OIG ScrutinyJune 20th, 2023 - Wyn StaheliEvery year the Department of Health & Human Services Office of Inspector General (OIG) creates an official work plan giving everyone a heads up as to what they are going to be reviewing. The 2022 Work Plan stated that they would be reviewing claims for Evaluation & Management services provided in an emergency department (ED) setting.
OIG Audit Reveals Diagnosis Reporting Problems Affecting Risk Adjustment ScoringJune 15th, 2023 - Wyn StaheliThe Office of the Inspector General (OIG) recently published their Spring 2023 Semiannual Report to Congress. This report contained some diagnoses reporting issues that all providers need to be aware of. They focused on several groups of diagnoses that they considered “High-Risk” for being miscoded. Several states were included in the report and the types of errors for all can be generally grouped into several categories.
Documenting for Suture and Staple Removal E/M Add-On CodesMay 30th, 2023 - Aimee WilcoxHistorically, the 10-day and 90-day global periods would include the patient's follow-up Evaluation and Management (E/M) services and any dressing changes or staple/suture removal related to the surgery; however, following a closer analysis of these and other surgery codes, the decision was made to make significant revisions to these codes to ensure proper reporting.