copapedia editor please confirm discrepency with Family meeting articles

to cite...author of article "Family meetings without patient present" was authored by copapedia editor and it states "you can typically" bill the family member who requested the service" and then in the forum discussion thread named Family counseling, copapedia editor states "remember, too that the patient will get the EOB that shows that they visited on a day they didn't have an appointment.
Please clarify when it is not a medicare pt (as we all know can't be billed) who we should under; the pt or the person presenting in place of pt.

family psychotherapy codes

The Medicare National Coverage Determinations Manual, Chapter 1, Section 70.1, states that family psychotherapy services are covered only where the primary purpose of such psychotherapy is the treatment of the patient's condition. Examples include:
I. When there is a need to observe and correct, through psychotherapeutic techniques, the patient's interaction with family members (90847).
II. Where there is a need to assess the conflicts or impediments within the family, and assist, through psychotherapy, the family members in the management of the patient (90846 or 90847).
The term "family" may apply to traditional family members, live-in companions, or significant others involved in the care of the patient. Codes 90846 and 90847 are not timed but are typically 45 to 60 minutes in duration.

but who does the bill go under?

Hi Nancy,

I know it is Friday, and I am probably missing something in front of my nose but I am still not clear on if you bill the pt or the pt family member when the pt is not present. (when it is not medicare) The articles led me to hear it two different ways and I just would like clarification on thiat.

bill

It depends, Medicare will pay if this is psychotherapy as described, under patient because the code describes patient not present. For private payers and non-psychotherapy encounters talking with family about the patient's condition in general is usually considered part of Dr/Pt relationship and not separately billed. Private payers also set their own policies, so, I never say never, but this should be in writing from private payer.

Medicare, not psychotherapy

When a family comes to the office to talk about a patient who is not there, Medicare is clear that the beneficiary must be present to bill Medicare in such a scenario. No Medicare patient present, no bill to Medicare. Private payers option- make it clear to caregivers or relatives in advance that the visit will be on a cash basis.
Again verify with key payers.

Family meetings

For Medicare, no billing. If you're the primary care provider, you aren't providing Psychotherapy to the family members. I know primary care providers do counseling all day in the midst of their office visits, but they don't use the psychotherapy codes. It doesn't really describe the service.

For commercial patients, call your payer. Ask them: does the patient have to be present? Can we bill you under the patient's Health Information ID, with the V code that describes seeking counseling on behalf of another. If they say yes, do it. The patient needs to know because they'll get an EOB. Ask for something in writing.

If they say no, ask if you can bill the family member. (Typically, if they consider it bundled, it is not billable, if they consider it non-covered, billable.)

That's how you will get your answer.

Family psychotherapy codes

I don't think that this describes the service that is being performed. Primary care providers don't typically use the psychiatry codes. If they did, for commercial carriers, they'd be denied as "not in our behavioral health network." Psychotherapy is a service provided over a period of time, not one visit in which the patient's family member comes in for a conference about what to do about the patient.

The manual says "observe and correct, through psychotherapeutic techniques." Discussion about the patient's illness and what to do next doesn't sound that like that to me.

I know: there is a lot of pressure on primary care. It is 30-60 minutes of physician time. We hate to tell them they can't bill it.

They can't bill it.