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  • Melinda
    Does anyone know if there is an E&M Code for when a patients family member comes in the office to discuss the patients status without the patient being
    Message 1 of 14 , Jul 9, 2007
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      Does anyone know if there is an E&M Code for when a patients family
      member comes in the office to discuss the patients status without the
      patient being present?

      I have heard mixed on this issue. Some say there is none, & to
      charge the patient's family member who comes in. Others say it's OK
      to code an E/M. What about if the patient's family comes in to
      discuss the patient's situation with doctor and the pt is disabled
      (mentally retarded) & was not present at the appointment? Or, say if
      it was an elderly person and the family was here to discuss whether
      or not to put patient in a nursing home, or hospice, etc.

      We had a patient's Mom come in to discuss her mentally retarded
      daughter. Dr. documented the daughter's chart and 99213. I'm just
      wondering if it's OK to bill 99213, or if I should charge the
      patient's Mom for doctor's time and not bill insurance.

      I see in the E/M Guidelines that it says "Face-to-face time (office
      and other outpatient visits and office consultations): For coding
      purposes, face-to-face time for these services is defined as only
      that time that the physician spends face-to-face with the patient
      and/or family." Also, in the section of "Complexity of Medical
      Decision Making" regarding Time: "When counseling and/or coordination
      of care dominates (more than 50%) the physician/patient and/or family
      encounter, then time may be considered the key or controlling factor
      to qualify for a particular level of E/M services. This includes time
      spend with parties who have assumed responsibility for the care of
      the patient or decision making whether or not they are family members
      (eg, foster parents, person acting in locum parentis, legal
      guardian). The extend of counseling and/or coordination of care must
      be documented in the medical record."

      I'm just wondering how to code/bill. Any help would be greatly
      appreciated.

      Thanks!

      Melinda Brown, CMBS
      Ins Biller
    • debbie brosnan
      Melinda, 9921X discription reads the physician typically spends x number of minutes face to face with the patient and/or family. You can bill an E/M with the
      Message 2 of 14 , Jul 9, 2007
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        Melinda,

        9921X discription reads the physician typically spends x number of minutes face to face with the patient and/or family.

        You can bill an E/M with the parent or family of a patient needs to speak with the doctor.

        Hope this helps.

        Deb

        Melinda <melindadocsmith@...> wrote:
        Does anyone know if there is an E&M Code for when a patients family
        member comes in the office to discuss the patients status without the
        patient being present?

        I have heard mixed on this issue. Some say there is none, & to
        charge the patient's family member who comes in. Others say it's OK
        to code an E/M. What about if the patient's family comes in to
        discuss the patient's situation with doctor and the pt is disabled
        (mentally retarded) & was not present at the appointment? Or, say if
        it was an elderly person and the family was here to discuss whether
        or not to put patient in a nursing home, or hospice, etc.

        We had a patient's Mom come in to discuss her mentally retarded
        daughter. Dr. documented the daughter's chart and 99213. I'm just
        wondering if it's OK to bill 99213, or if I should charge the
        patient's Mom for doctor's time and not bill insurance.

        I see in the E/M Guidelines that it says "Face-to-face time (office
        and other outpatient visits and office consultations): For coding
        purposes, face-to-face time for these services is defined as only
        that time that the physician spends face-to-face with the patient
        and/or family." Also, in the section of "Complexity of Medical
        Decision Making" regarding Time: "When counseling and/or coordination
        of care dominates (more than 50%) the physician/patient and/or family
        encounter, then time may be considered the key or controlling factor
        to qualify for a particular level of E/M services. This includes time
        spend with parties who have assumed responsibility for the care of
        the patient or decision making whether or not they are family members
        (eg, foster parents, person acting in locum parentis, legal
        guardian). The extend of counseling and/or coordination of care must
        be documented in the medical record."

        I'm just wondering how to code/bill. Any help would be greatly
        appreciated.

        Thanks!

        Melinda Brown, CMBS
        Ins Biller






        [Non-text portions of this message have been removed]
      • Melinda
        Yea! I was hoping that was the case. Thanks Deb! Melinda ... number of minutes face to face with the patient and/or family. ... to speak with the doctor. ...
        Message 3 of 14 , Jul 9, 2007
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          Yea! I was hoping that was the case. Thanks Deb!

          Melinda

          --- In MedicalBillers@yahoogroups.com, debbie brosnan
          <thebiller_2000@...> wrote:
          >
          > Melinda,
          >
          > 9921X discription reads the physician typically spends x
          number of minutes face to face with the patient and/or family.
          >
          > You can bill an E/M with the parent or family of a patient needs
          to speak with the doctor.
          >
          > Hope this helps.
          >
          > Deb
          >
          > Melinda <melindadocsmith@...> wrote:
          > Does anyone know if there is an E&M Code for when a
          patients family
          > member comes in the office to discuss the patients status without
          the
          > patient being present?
          >
          > I have heard mixed on this issue. Some say there is none, & to
          > charge the patient's family member who comes in. Others say it's OK
          > to code an E/M. What about if the patient's family comes in to
          > discuss the patient's situation with doctor and the pt is disabled
          > (mentally retarded) & was not present at the appointment? Or, say
          if
          > it was an elderly person and the family was here to discuss whether
          > or not to put patient in a nursing home, or hospice, etc.
          >
          > We had a patient's Mom come in to discuss her mentally retarded
          > daughter. Dr. documented the daughter's chart and 99213. I'm just
          > wondering if it's OK to bill 99213, or if I should charge the
          > patient's Mom for doctor's time and not bill insurance.
          >
          > I see in the E/M Guidelines that it says "Face-to-face time (office
          > and other outpatient visits and office consultations): For coding
          > purposes, face-to-face time for these services is defined as only
          > that time that the physician spends face-to-face with the patient
          > and/or family." Also, in the section of "Complexity of Medical
          > Decision Making" regarding Time: "When counseling and/or
          coordination
          > of care dominates (more than 50%) the physician/patient and/or
          family
          > encounter, then time may be considered the key or controlling
          factor
          > to qualify for a particular level of E/M services. This includes
          time
          > spend with parties who have assumed responsibility for the care of
          > the patient or decision making whether or not they are family
          members
          > (eg, foster parents, person acting in locum parentis, legal
          > guardian). The extend of counseling and/or coordination of care
          must
          > be documented in the medical record."
          >
          > I'm just wondering how to code/bill. Any help would be greatly
          > appreciated.
          >
          > Thanks!
          >
          > Melinda Brown, CMBS
          > Ins Biller
          >
          >
          >
          >
          >
          >
          > [Non-text portions of this message have been removed]
          >
        • B Burgess
          Unless it is a m care pt, then it is NOT billable. Barbara Burgess, RN, CPC, ACS-EM Melinda wrote: Yea! I was hoping that was the
          Message 4 of 14 , Jul 9, 2007
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            Unless it is a m'care pt, then it is NOT billable.

            Barbara Burgess, RN, CPC, ACS-EM

            Melinda <melindadocsmith@...> wrote:
            Yea! I was hoping that was the case. Thanks Deb!

            Melinda

            --- In MedicalBillers@yahoogroups.com, debbie brosnan
            <thebiller_2000@...> wrote:
            >
            > Melinda,
            >
            > 9921X discription reads the physician typically spends x
            number of minutes face to face with the patient and/or family.
            >
            > You can bill an E/M with the parent or family of a patient needs
            to speak with the doctor.
            >
            > Hope this helps.
            >
            > Deb
            >
            > Melinda <melindadocsmith@...> wrote:
            > Does anyone know if there is an E&M Code for when a
            patients family
            > member comes in the office to discuss the patients status without
            the
            > patient being present?
            >
            > I have heard mixed on this issue. Some say there is none, & to
            > charge the patient's family member who comes in. Others say it's OK
            > to code an E/M. What about if the patient's family comes in to
            > discuss the patient's situation with doctor and the pt is disabled
            > (mentally retarded) & was not present at the appointment? Or, say
            if
            > it was an elderly person and the family was here to discuss whether
            > or not to put patient in a nursing home, or hospice, etc.
            >
            > We had a patient's Mom come in to discuss her mentally retarded
            > daughter. Dr. documented the daughter's chart and 99213. I'm just
            > wondering if it's OK to bill 99213, or if I should charge the
            > patient's Mom for doctor's time and not bill insurance.
            >
            > I see in the E/M Guidelines that it says "Face-to-face time (office
            > and other outpatient visits and office consultations): For coding
            > purposes, face-to-face time for these services is defined as only
            > that time that the physician spends face-to-face with the patient
            > and/or family." Also, in the section of "Complexity of Medical
            > Decision Making" regarding Time: "When counseling and/or
            coordination
            > of care dominates (more than 50%) the physician/patient and/or
            family
            > encounter, then time may be considered the key or controlling
            factor
            > to qualify for a particular level of E/M services. This includes
            time
            > spend with parties who have assumed responsibility for the care of
            > the patient or decision making whether or not they are family
            members
            > (eg, foster parents, person acting in locum parentis, legal
            > guardian). The extend of counseling and/or coordination of care
            must
            > be documented in the medical record."
            >
            > I'm just wondering how to code/bill. Any help would be greatly
            > appreciated.
            >
            > Thanks!
            >
            > Melinda Brown, CMBS
            > Ins Biller
            >
            >
            >
            >
            >
            >
            > [Non-text portions of this message have been removed]
            >






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          • debbie brosnan
            Barbara, Where did you get your information? Deb B Burgess wrote: Unless it is a m care pt, then it is NOT billable. Barbara Burgess, RN,
            Message 5 of 14 , Jul 9, 2007
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              Barbara,

              Where did you get your information?

              Deb

              B Burgess <granbfly@...> wrote:
              Unless it is a m'care pt, then it is NOT billable.

              Barbara Burgess, RN, CPC, ACS-EM

              Melinda <melindadocsmith@...> wrote:
              Yea! I was hoping that was the case. Thanks Deb!

              Melinda

              --- In MedicalBillers@yahoogroups.com, debbie brosnan
              <thebiller_2000@...> wrote:
              >
              > Melinda,
              >
              > 9921X discription reads the physician typically spends x
              number of minutes face to face with the patient and/or family.
              >
              > You can bill an E/M with the parent or family of a patient needs
              to speak with the doctor.
              >
              > Hope this helps.
              >
              > Deb
              >
              > Melinda <melindadocsmith@...> wrote:
              > Does anyone know if there is an E&M Code for when a
              patients family
              > member comes in the office to discuss the patients status without
              the
              > patient being present?
              >
              > I have heard mixed on this issue. Some say there is none, & to
              > charge the patient's family member who comes in. Others say it's OK
              > to code an E/M. What about if the patient's family comes in to
              > discuss the patient's situation with doctor and the pt is disabled
              > (mentally retarded) & was not present at the appointment? Or, say
              if
              > it was an elderly person and the family was here to discuss whether
              > or not to put patient in a nursing home, or hospice, etc.
              >
              > We had a patient's Mom come in to discuss her mentally retarded
              > daughter. Dr. documented the daughter's chart and 99213. I'm just
              > wondering if it's OK to bill 99213, or if I should charge the
              > patient's Mom for doctor's time and not bill insurance.
              >
              > I see in the E/M Guidelines that it says "Face-to-face time (office
              > and other outpatient visits and office consultations): For coding
              > purposes, face-to-face time for these services is defined as only
              > that time that the physician spends face-to-face with the patient
              > and/or family." Also, in the section of "Complexity of Medical
              > Decision Making" regarding Time: "When counseling and/or
              coordination
              > of care dominates (more than 50%) the physician/patient and/or
              family
              > encounter, then time may be considered the key or controlling
              factor
              > to qualify for a particular level of E/M services. This includes
              time
              > spend with parties who have assumed responsibility for the care of
              > the patient or decision making whether or not they are family
              members
              > (eg, foster parents, person acting in locum parentis, legal
              > guardian). The extend of counseling and/or coordination of care
              must
              > be documented in the medical record."
              >
              > I'm just wondering how to code/bill. Any help would be greatly
              > appreciated.
              >
              > Thanks!
              >
              > Melinda Brown, CMBS
              > Ins Biller
              >
              >
              >
              >
              >
              >
              > [Non-text portions of this message have been removed]
              >

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            • B Burgess
              It was discussed on the partbnews listserv recently........... I ll see if I can find the cite. Barbara debbie brosnan wrote:
              Message 6 of 14 , Jul 9, 2007
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                It was discussed on the partbnews listserv recently........... I'll see if I can find the cite.

                Barbara

                debbie brosnan <thebiller_2000@...> wrote:
                Barbara,

                Where did you get your information?

                Deb

                B Burgess <granbfly@...> wrote:
                Unless it is a m'care pt, then it is NOT billable.

                Barbara Burgess, RN, CPC, ACS-EM

                Melinda <melindadocsmith@...> wrote:
                Yea! I was hoping that was the case. Thanks Deb!

                Melinda

                --- In MedicalBillers@yahoogroups.com, debbie brosnan
                <thebiller_2000@...> wrote:
                >
                > Melinda,
                >
                > 9921X discription reads the physician typically spends x
                number of minutes face to face with the patient and/or family.
                >
                > You can bill an E/M with the parent or family of a patient needs
                to speak with the doctor.
                >
                > Hope this helps.
                >
                > Deb
                >
                > Melinda <melindadocsmith@...> wrote:
                > Does anyone know if there is an E&M Code for when a
                patients family
                > member comes in the office to discuss the patients status without
                the
                > patient being present?
                >
                > I have heard mixed on this issue. Some say there is none, & to
                > charge the patient's family member who comes in. Others say it's OK
                > to code an E/M. What about if the patient's family comes in to
                > discuss the patient's situation with doctor and the pt is disabled
                > (mentally retarded) & was not present at the appointment? Or, say
                if
                > it was an elderly person and the family was here to discuss whether
                > or not to put patient in a nursing home, or hospice, etc.
                >
                > We had a patient's Mom come in to discuss her mentally retarded
                > daughter. Dr. documented the daughter's chart and 99213. I'm just
                > wondering if it's OK to bill 99213, or if I should charge the
                > patient's Mom for doctor's time and not bill insurance.
                >
                > I see in the E/M Guidelines that it says "Face-to-face time (office
                > and other outpatient visits and office consultations): For coding
                > purposes, face-to-face time for these services is defined as only
                > that time that the physician spends face-to-face with the patient
                > and/or family." Also, in the section of "Complexity of Medical
                > Decision Making" regarding Time: "When counseling and/or
                coordination
                > of care dominates (more than 50%) the physician/patient and/or
                family
                > encounter, then time may be considered the key or controlling
                factor
                > to qualify for a particular level of E/M services. This includes
                time
                > spend with parties who have assumed responsibility for the care of
                > the patient or decision making whether or not they are family
                members
                > (eg, foster parents, person acting in locum parentis, legal
                > guardian). The extend of counseling and/or coordination of care
                must
                > be documented in the medical record."
                >
                > I'm just wondering how to code/bill. Any help would be greatly
                > appreciated.
                >
                > Thanks!
                >
                > Melinda Brown, CMBS
                > Ins Biller
                >
                >
                >
                >
                >
                >
                > [Non-text portions of this message have been removed]
                >

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              • B Burgess
                Still looking for the actual cite from m care, but here is one of the answers as explained on the recent thread............ The link to the entire thread is
                Message 7 of 14 , Jul 9, 2007
                • 0 Attachment
                  Still looking for the actual cite from m'care, but here is one of the answers as explained on the recent thread............

                  The link to the entire thread is http://lists.ucg.com/read/messages?id=684024#684024

                  "It is written in the coverage manuals and in the Social Security Act
                  defining a visit as face to face.. Medicare has repeatedly said in Open
                  Door Forums and in correspondence that the patient must be present [Medicaid
                  is the same unless the State Waiver changes this]. Medicare also analyzes
                  it this way: in Hsiao's research which is the basis of the RVU system as we
                  know it, time consulting with families was considered in the development
                  of the Relative Value Unit for office/clinic based services. Therefore,
                  Family visits without the patient present [except for those meeting the
                  criteria or 90846] are already paid for in the RVU calculation are are
                  irretrievably bundled into the office/clinic visit code, and are NOT allowed to be
                  unbundled and billed to the family. CPT takes a different view and for
                  the Payors who tell you to use CPT rules, you can bill either the family or
                  the payor using E&M codes. However, I'd generally bill to the family as some
                  payors have written policy somewhere saying you can't bill them but you
                  can bill the family.



                  Quin

                  Quinten A. Buechner, M.S., M.Div.,
                  ACS-FP/GI/PEDS, CPC, CCP, CMSCS
                  President, ProActive Consultants, LLC
                  1659 3rd Avenue "


                  Does that help ?

                  Barbara Burgess, RN,CPC,ACS-EM



                  debbie brosnan <thebiller_2000@...> wrote:
                  Barbara,

                  Where did you get your information?

                  Deb

                  B Burgess <granbfly@...> wrote:
                  Unless it is a m'care pt, then it is NOT billable.

                  Barbara Burgess, RN, CPC, ACS-EM

                  Melinda <melindadocsmith@...> wrote:
                  Yea! I was hoping that was the case. Thanks Deb!

                  Melinda

                  --- In MedicalBillers@yahoogroups.com, debbie brosnan
                  <thebiller_2000@...> wrote:
                  >
                  > Melinda,
                  >
                  > 9921X discription reads the physician typically spends x
                  number of minutes face to face with the patient and/or family.
                  >
                  > You can bill an E/M with the parent or family of a patient needs
                  to speak with the doctor.
                  >
                  > Hope this helps.
                  >
                  > Deb
                  >
                  > Melinda <melindadocsmith@...> wrote:
                  > Does anyone know if there is an E&M Code for when a
                  patients family
                  > member comes in the office to discuss the patients status without
                  the
                  > patient being present?
                  >
                  > I have heard mixed on this issue. Some say there is none, & to
                  > charge the patient's family member who comes in. Others say it's OK
                  > to code an E/M. What about if the patient's family comes in to
                  > discuss the patient's situation with doctor and the pt is disabled
                  > (mentally retarded) & was not present at the appointment? Or, say
                  if
                  > it was an elderly person and the family was here to discuss whether
                  > or not to put patient in a nursing home, or hospice, etc.
                  >
                  > We had a patient's Mom come in to discuss her mentally retarded
                  > daughter. Dr. documented the daughter's chart and 99213. I'm just
                  > wondering if it's OK to bill 99213, or if I should charge the
                  > patient's Mom for doctor's time and not bill insurance.
                  >
                  > I see in the E/M Guidelines that it says "Face-to-face time (office
                  > and other outpatient visits and office consultations): For coding
                  > purposes, face-to-face time for these services is defined as only
                  > that time that the physician spends face-to-face with the patient
                  > and/or family." Also, in the section of "Complexity of Medical
                  > Decision Making" regarding Time: "When counseling and/or
                  coordination
                  > of care dominates (more than 50%) the physician/patient and/or
                  family
                  > encounter, then time may be considered the key or controlling
                  factor
                  > to qualify for a particular level of E/M services. This includes
                  time
                  > spend with parties who have assumed responsibility for the care of
                  > the patient or decision making whether or not they are family
                  members
                  > (eg, foster parents, person acting in locum parentis, legal
                  > guardian). The extend of counseling and/or coordination of care
                  must
                  > be documented in the medical record."
                  >
                  > I'm just wondering how to code/bill. Any help would be greatly
                  > appreciated.
                  >
                  > Thanks!
                  >
                  > Melinda Brown, CMBS
                  > Ins Biller
                  >
                  >
                  >
                  >
                  >
                  >
                  > [Non-text portions of this message have been removed]
                  >

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                • debbie brosnan
                  That would be great. Because here in Michigan I can tell you its being billed and being paid. Your saying if its not Medicare dont bill it. Or if it is
                  Message 8 of 14 , Jul 9, 2007
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                    That would be great. Because here in Michigan I can tell you its being billed and being paid. Your saying if its not Medicare dont bill it. Or if it is Medicare dont bill it?

                    B Burgess <granbfly@...> wrote: It was discussed on the partbnews listserv recently........... I'll see if I can find the cite.

                    Barbara

                    debbie brosnan <thebiller_2000@...> wrote:
                    Barbara,

                    Where did you get your information?

                    Deb

                    B Burgess <granbfly@...> wrote:
                    Unless it is a m'care pt, then it is NOT billable.

                    Barbara Burgess, RN, CPC, ACS-EM

                    Melinda <melindadocsmith@...> wrote:
                    Yea! I was hoping that was the case. Thanks Deb!

                    Melinda

                    --- In MedicalBillers@yahoogroups.com, debbie brosnan
                    <thebiller_2000@...> wrote:
                    >
                    > Melinda,
                    >
                    > 9921X discription reads the physician typically spends x
                    number of minutes face to face with the patient and/or family.
                    >
                    > You can bill an E/M with the parent or family of a patient needs
                    to speak with the doctor.
                    >
                    > Hope this helps.
                    >
                    > Deb
                    >
                    > Melinda <melindadocsmith@...> wrote:
                    > Does anyone know if there is an E&M Code for when a
                    patients family
                    > member comes in the office to discuss the patients status without
                    the
                    > patient being present?
                    >
                    > I have heard mixed on this issue. Some say there is none, & to
                    > charge the patient's family member who comes in. Others say it's OK
                    > to code an E/M. What about if the patient's family comes in to
                    > discuss the patient's situation with doctor and the pt is disabled
                    > (mentally retarded) & was not present at the appointment? Or, say
                    if
                    > it was an elderly person and the family was here to discuss whether
                    > or not to put patient in a nursing home, or hospice, etc.
                    >
                    > We had a patient's Mom come in to discuss her mentally retarded
                    > daughter. Dr. documented the daughter's chart and 99213. I'm just
                    > wondering if it's OK to bill 99213, or if I should charge the
                    > patient's Mom for doctor's time and not bill insurance.
                    >
                    > I see in the E/M Guidelines that it says "Face-to-face time (office
                    > and other outpatient visits and office consultations): For coding
                    > purposes, face-to-face time for these services is defined as only
                    > that time that the physician spends face-to-face with the patient
                    > and/or family." Also, in the section of "Complexity of Medical
                    > Decision Making" regarding Time: "When counseling and/or
                    coordination
                    > of care dominates (more than 50%) the physician/patient and/or
                    family
                    > encounter, then time may be considered the key or controlling
                    factor
                    > to qualify for a particular level of E/M services. This includes
                    time
                    > spend with parties who have assumed responsibility for the care of
                    > the patient or decision making whether or not they are family
                    members
                    > (eg, foster parents, person acting in locum parentis, legal
                    > guardian). The extend of counseling and/or coordination of care
                    must
                    > be documented in the medical record."
                    >
                    > I'm just wondering how to code/bill. Any help would be greatly
                    > appreciated.
                    >
                    > Thanks!
                    >
                    > Melinda Brown, CMBS
                    > Ins Biller
                    >
                    >
                    >
                    >
                    >
                    >
                    > [Non-text portions of this message have been removed]
                    >

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                  • B Burgess
                    http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf C. Selection Of Level Of Evaluation and Management Service Based On Duration Of Coordination Of Care
                    Message 9 of 14 , Jul 9, 2007
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                      http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

                      C. Selection Of Level Of Evaluation and Management Service Based On Duration Of Coordination Of Care and/or Counseling
                      Advise physicians that when counseling and/or coordination of care dominates (more than 50 percent) the face-to-face physician/patient encounter or the floor time (in the case of inpatient services), time is the key or controlling factor in selecting the level of service. In general, to bill an E/M code, the physician must complete at least 2 out of 3 criteria applicable to the type/level of service provided. However, the physician may document time spent with the patient in conjunction with the medical decision-making involved and a description of the coordination of care or counseling provided. Documentation must be in sufficient detail to support the claim.
                      EXAMPLE: A cancer patient has had all preliminary studies completed and a medical decision to implement chemotherapy. At an office visit the physician discusses the treatment options and subsequent lifestyle effects of treatment the patient may encounter or is experiencing. The physician need not complete a history and physical examination in order to select the level of service. The time spent in counseling/coordination of care and medical decision-making will determine the level of service billed.
                      The code selection is based on the total time of the face-to-face encounter or floor time, not just the counseling time. The medical record must be documented in sufficient detail to justify the selection of the specific code if time is the basis for selection of the code.
                      In the office and other outpatient setting, counseling and/or coordination of care must be provided in the presence of the patient if the time spent providing those services is used to determine the level of service reported. Face-to-face time refers to the time with the physician only. Counseling by other staff is not considered to be part of the face-to-face physician/patient encounter time. Therefore, the time spent by the other staff is not considered in selecting the appropriate level of service. The code used depends upon the physician service provided.
                      In an inpatient setting, the counseling and/or coordination of care must be provided at the bedside or on the patient’s hospital floor or unit that is associated with an individual patient. Time spent counseling the patient or coordinating the patient’s care after the patient has left the office or the physician has left the patient’s floor or begun to care for

                      another patient on the floor is not considered when selecting the level of service to be reported.
                      The duration of counseling or coordination of care that is provided face-to-face or on the floor may be estimated but that estimate, along with the total duration of the visit, must be recorded when time is used for the selection of the level of a service that involves predominantly coordination of care or counseling.


                      Barbara


                      debbie brosnan <thebiller_2000@...> wrote: Barbara,

                      Where did you get your information?

                      Deb

                      B Burgess <granbfly@...> wrote:
                      Unless it is a m'care pt, then it is NOT billable.

                      Barbara Burgess, RN, CPC, ACS-EM

                      Melinda <melindadocsmith@...> wrote:
                      Yea! I was hoping that was the case. Thanks Deb!

                      Melinda

                      --- In MedicalBillers@yahoogroups.com, debbie brosnan
                      <thebiller_2000@...> wrote:
                      >
                      > Melinda,
                      >
                      > 9921X discription reads the physician typically spends x
                      number of minutes face to face with the patient and/or family.
                      >
                      > You can bill an E/M with the parent or family of a patient needs
                      to speak with the doctor.
                      >
                      > Hope this helps.
                      >
                      > Deb
                      >
                      > Melinda <melindadocsmith@...> wrote:
                      > Does anyone know if there is an E&M Code for when a
                      patients family
                      > member comes in the office to discuss the patients status without
                      the
                      > patient being present?
                      >
                      > I have heard mixed on this issue. Some say there is none, & to
                      > charge the patient's family member who comes in. Others say it's OK
                      > to code an E/M. What about if the patient's family comes in to
                      > discuss the patient's situation with doctor and the pt is disabled
                      > (mentally retarded) & was not present at the appointment? Or, say
                      if
                      > it was an elderly person and the family was here to discuss whether
                      > or not to put patient in a nursing home, or hospice, etc.
                      >
                      > We had a patient's Mom come in to discuss her mentally retarded
                      > daughter. Dr. documented the daughter's chart and 99213. I'm just
                      > wondering if it's OK to bill 99213, or if I should charge the
                      > patient's Mom for doctor's time and not bill insurance.
                      >
                      > I see in the E/M Guidelines that it says "Face-to-face time (office
                      > and other outpatient visits and office consultations): For coding
                      > purposes, face-to-face time for these services is defined as only
                      > that time that the physician spends face-to-face with the patient
                      > and/or family." Also, in the section of "Complexity of Medical
                      > Decision Making" regarding Time: "When counseling and/or
                      coordination
                      > of care dominates (more than 50%) the physician/patient and/or
                      family
                      > encounter, then time may be considered the key or controlling
                      factor
                      > to qualify for a particular level of E/M services. This includes
                      time
                      > spend with parties who have assumed responsibility for the care of
                      > the patient or decision making whether or not they are family
                      members
                      > (eg, foster parents, person acting in locum parentis, legal
                      > guardian). The extend of counseling and/or coordination of care
                      must
                      > be documented in the medical record."
                      >
                      > I'm just wondering how to code/bill. Any help would be greatly
                      > appreciated.
                      >
                      > Thanks!
                      >
                      > Melinda Brown, CMBS
                      > Ins Biller
                      >
                      >
                      >
                      >
                      >
                      >
                      > [Non-text portions of this message have been removed]
                      >

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                    • debbie brosnan
                      Yes, thanks. I think as far as Non Medicare payors, and not being disputed from the carrier. I d follow CPT rules and bill. B Burgess
                      Message 10 of 14 , Jul 9, 2007
                      • 0 Attachment
                        Yes, thanks. I think as far as Non Medicare payors, and not being disputed from the carrier. I'd follow CPT rules and bill.

                        B Burgess <granbfly@...> wrote: Still looking for the actual cite from m'care, but here is one of the answers as explained on the recent thread............

                        The link to the entire thread is http://lists.ucg.com/read/messages?id=684024#684024

                        "It is written in the coverage manuals and in the Social Security Act
                        defining a visit as face to face.. Medicare has repeatedly said in Open
                        Door Forums and in correspondence that the patient must be present [Medicaid
                        is the same unless the State Waiver changes this]. Medicare also analyzes
                        it this way: in Hsiao's research which is the basis of the RVU system as we
                        know it, time consulting with families was considered in the development
                        of the Relative Value Unit for office/clinic based services. Therefore,
                        Family visits without the patient present [except for those meeting the
                        criteria or 90846] are already paid for in the RVU calculation are are
                        irretrievably bundled into the office/clinic visit code, and are NOT allowed to be
                        unbundled and billed to the family. CPT takes a different view and for
                        the Payors who tell you to use CPT rules, you can bill either the family or
                        the payor using E&M codes. However, I'd generally bill to the family as some
                        payors have written policy somewhere saying you can't bill them but you
                        can bill the family.

                        Quin

                        Quinten A. Buechner, M.S., M.Div.,
                        ACS-FP/GI/PEDS, CPC, CCP, CMSCS
                        President, ProActive Consultants, LLC
                        1659 3rd Avenue "


                        Does that help ?

                        Barbara Burgess, RN,CPC,ACS-EM


                        debbie brosnan <thebiller_2000@...> wrote:
                        Barbara,

                        Where did you get your information?

                        Deb

                        B Burgess <granbfly@...> wrote:
                        Unless it is a m'care pt, then it is NOT billable.

                        Barbara Burgess, RN, CPC, ACS-EM

                        Melinda <melindadocsmith@...> wrote:
                        Yea! I was hoping that was the case. Thanks Deb!

                        Melinda

                        --- In MedicalBillers@yahoogroups.com, debbie brosnan
                        <thebiller_2000@...> wrote:
                        >
                        > Melinda,
                        >
                        > 9921X discription reads the physician typically spends x
                        number of minutes face to face with the patient and/or family.
                        >
                        > You can bill an E/M with the parent or family of a patient needs
                        to speak with the doctor.
                        >
                        > Hope this helps.
                        >
                        > Deb
                        >
                        > Melinda <melindadocsmith@...> wrote:
                        > Does anyone know if there is an E&M Code for when a
                        patients family
                        > member comes in the office to discuss the patients status without
                        the
                        > patient being present?
                        >
                        > I have heard mixed on this issue. Some say there is none, & to
                        > charge the patient's family member who comes in. Others say it's OK
                        > to code an E/M. What about if the patient's family comes in to
                        > discuss the patient's situation with doctor and the pt is disabled
                        > (mentally retarded) & was not present at the appointment? Or, say
                        if
                        > it was an elderly person and the family was here to discuss whether
                        > or not to put patient in a nursing home, or hospice, etc.
                        >
                        > We had a patient's Mom come in to discuss her mentally retarded
                        > daughter. Dr. documented the daughter's chart and 99213. I'm just
                        > wondering if it's OK to bill 99213, or if I should charge the
                        > patient's Mom for doctor's time and not bill insurance.
                        >
                        > I see in the E/M Guidelines that it says "Face-to-face time (office
                        > and other outpatient visits and office consultations): For coding
                        > purposes, face-to-face time for these services is defined as only
                        > that time that the physician spends face-to-face with the patient
                        > and/or family." Also, in the section of "Complexity of Medical
                        > Decision Making" regarding Time: "When counseling and/or
                        coordination
                        > of care dominates (more than 50%) the physician/patient and/or
                        family
                        > encounter, then time may be considered the key or controlling
                        factor
                        > to qualify for a particular level of E/M services. This includes
                        time
                        > spend with parties who have assumed responsibility for the care of
                        > the patient or decision making whether or not they are family
                        members
                        > (eg, foster parents, person acting in locum parentis, legal
                        > guardian). The extend of counseling and/or coordination of care
                        must
                        > be documented in the medical record."
                        >
                        > I'm just wondering how to code/bill. Any help would be greatly
                        > appreciated.
                        >
                        > Thanks!
                        >
                        > Melinda Brown, CMBS
                        > Ins Biller
                        >
                        >
                        >
                        >
                        >
                        >
                        > [Non-text portions of this message have been removed]
                        >

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                      • B Burgess
                        Do not bill it for M care and prob not most M caids. AND, some BC/BS payors are also saying they will not pay because M care won t. If you are going to bill
                        Message 11 of 14 , Jul 9, 2007
                        • 0 Attachment
                          Do not bill it for M'care and prob not most M'caids. AND, some BC/BS payors are also saying they will not pay because M'care won't. If you are going to bill it to carriers that will pay, be sure to document and code based on time as you won't have the patient there so you can't document an HPI, ROS, etc nor exam. Therefore, you can only document the counseling time. CPT clearly states this is billable, but M'care says face to face only for clinic or outpt. You could bill the family member counseling as coordination of care for inpatient, but the patient of course would have to be inpt and the doc would need to be talking to the family on the hospital floor. This would be acceptable to bill (again, based on time) especially if the pt was not able to make decisions regarding treatment options, DNR, etc.

                          Barbara Burgess, RN, CPC,ACS-EM

                          I sent some links and a section of M'care IOM in another email.

                          debbie brosnan <thebiller_2000@...> wrote:
                          That would be great. Because here in Michigan I can tell you its being billed and being paid. Your saying if its not Medicare dont bill it. Or if it is Medicare dont bill it?

                          B Burgess <granbfly@...> wrote: It was discussed on the partbnews listserv recently........... I'll see if I can find the cite.

                          Barbara

                          debbie brosnan <thebiller_2000@...> wrote:
                          Barbara,

                          Where did you get your information?

                          Deb

                          B Burgess <granbfly@...> wrote:
                          Unless it is a m'care pt, then it is NOT billable.

                          Barbara Burgess, RN, CPC, ACS-EM

                          Melinda <melindadocsmith@...> wrote:
                          Yea! I was hoping that was the case. Thanks Deb!

                          Melinda

                          --- In MedicalBillers@yahoogroups.com, debbie brosnan
                          <thebiller_2000@...> wrote:
                          >
                          > Melinda,
                          >
                          > 9921X discription reads the physician typically spends x
                          number of minutes face to face with the patient and/or family.
                          >
                          > You can bill an E/M with the parent or family of a patient needs
                          to speak with the doctor.
                          >
                          > Hope this helps.
                          >
                          > Deb
                          >
                          > Melinda <melindadocsmith@...> wrote:
                          > Does anyone know if there is an E&M Code for when a
                          patients family
                          > member comes in the office to discuss the patients status without
                          the
                          > patient being present?
                          >
                          > I have heard mixed on this issue. Some say there is none, & to
                          > charge the patient's family member who comes in. Others say it's OK
                          > to code an E/M. What about if the patient's family comes in to
                          > discuss the patient's situation with doctor and the pt is disabled
                          > (mentally retarded) & was not present at the appointment? Or, say
                          if
                          > it was an elderly person and the family was here to discuss whether
                          > or not to put patient in a nursing home, or hospice, etc.
                          >
                          > We had a patient's Mom come in to discuss her mentally retarded
                          > daughter. Dr. documented the daughter's chart and 99213. I'm just
                          > wondering if it's OK to bill 99213, or if I should charge the
                          > patient's Mom for doctor's time and not bill insurance.
                          >
                          > I see in the E/M Guidelines that it says "Face-to-face time (office
                          > and other outpatient visits and office consultations): For coding
                          > purposes, face-to-face time for these services is defined as only
                          > that time that the physician spends face-to-face with the patient
                          > and/or family." Also, in the section of "Complexity of Medical
                          > Decision Making" regarding Time: "When counseling and/or
                          coordination
                          > of care dominates (more than 50%) the physician/patient and/or
                          family
                          > encounter, then time may be considered the key or controlling
                          factor
                          > to qualify for a particular level of E/M services. This includes
                          time
                          > spend with parties who have assumed responsibility for the care of
                          > the patient or decision making whether or not they are family
                          members
                          > (eg, foster parents, person acting in locum parentis, legal
                          > guardian). The extend of counseling and/or coordination of care
                          must
                          > be documented in the medical record."
                          >
                          > I'm just wondering how to code/bill. Any help would be greatly
                          > appreciated.
                          >
                          > Thanks!
                          >
                          > Melinda Brown, CMBS
                          > Ins Biller
                          >
                          >
                          >
                          >
                          >
                          >
                          > [Non-text portions of this message have been removed]
                          >

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                        • B Burgess
                          I agree, as long as the local carrier doesn t have any policy to the contrary. Again, just be sure time and nature of counseling is documented since you won t
                          Message 12 of 14 , Jul 9, 2007
                          • 0 Attachment
                            I agree, as long as the local carrier doesn't have any policy to the contrary. Again, just be sure time and nature of counseling is documented since you won't have the other elements of history and medical decision making !

                            Barbara Burgess, RN, CPC, ACS-EM

                            debbie brosnan <thebiller_2000@...> wrote:
                            Yes, thanks. I think as far as Non Medicare payors, and not being disputed from the carrier. I'd follow CPT rules and bill.

                            B Burgess <granbfly@...> wrote: Still looking for the actual cite from m'care, but here is one of the answers as explained on the recent thread............

                            The link to the entire thread is http://lists.ucg.com/read/messages?id=684024#684024

                            "It is written in the coverage manuals and in the Social Security Act
                            defining a visit as face to face.. Medicare has repeatedly said in Open
                            Door Forums and in correspondence that the patient must be present [Medicaid
                            is the same unless the State Waiver changes this]. Medicare also analyzes
                            it this way: in Hsiao's research which is the basis of the RVU system as we
                            know it, time consulting with families was considered in the development
                            of the Relative Value Unit for office/clinic based services. Therefore,
                            Family visits without the patient present [except for those meeting the
                            criteria or 90846] are already paid for in the RVU calculation are are
                            irretrievably bundled into the office/clinic visit code, and are NOT allowed to be
                            unbundled and billed to the family. CPT takes a different view and for
                            the Payors who tell you to use CPT rules, you can bill either the family or
                            the payor using E&M codes. However, I'd generally bill to the family as some
                            payors have written policy somewhere saying you can't bill them but you
                            can bill the family.

                            Quin

                            Quinten A. Buechner, M.S., M.Div.,
                            ACS-FP/GI/PEDS, CPC, CCP, CMSCS
                            President, ProActive Consultants, LLC
                            1659 3rd Avenue "

                            Does that help ?

                            Barbara Burgess, RN,CPC,ACS-EM

                            debbie brosnan <thebiller_2000@...> wrote:
                            Barbara,

                            Where did you get your information?

                            Deb

                            B Burgess <granbfly@...> wrote:
                            Unless it is a m'care pt, then it is NOT billable.

                            Barbara Burgess, RN, CPC, ACS-EM

                            Melinda <melindadocsmith@...> wrote:
                            Yea! I was hoping that was the case. Thanks Deb!

                            Melinda

                            --- In MedicalBillers@yahoogroups.com, debbie brosnan
                            <thebiller_2000@...> wrote:
                            >
                            > Melinda,
                            >
                            > 9921X discription reads the physician typically spends x
                            number of minutes face to face with the patient and/or family.
                            >
                            > You can bill an E/M with the parent or family of a patient needs
                            to speak with the doctor.
                            >
                            > Hope this helps.
                            >
                            > Deb
                            >
                            > Melinda <melindadocsmith@...> wrote:
                            > Does anyone know if there is an E&M Code for when a
                            patients family
                            > member comes in the office to discuss the patients status without
                            the
                            > patient being present?
                            >
                            > I have heard mixed on this issue. Some say there is none, & to
                            > charge the patient's family member who comes in. Others say it's OK
                            > to code an E/M. What about if the patient's family comes in to
                            > discuss the patient's situation with doctor and the pt is disabled
                            > (mentally retarded) & was not present at the appointment? Or, say
                            if
                            > it was an elderly person and the family was here to discuss whether
                            > or not to put patient in a nursing home, or hospice, etc.
                            >
                            > We had a patient's Mom come in to discuss her mentally retarded
                            > daughter. Dr. documented the daughter's chart and 99213. I'm just
                            > wondering if it's OK to bill 99213, or if I should charge the
                            > patient's Mom for doctor's time and not bill insurance.
                            >
                            > I see in the E/M Guidelines that it says "Face-to-face time (office
                            > and other outpatient visits and office consultations): For coding
                            > purposes, face-to-face time for these services is defined as only
                            > that time that the physician spends face-to-face with the patient
                            > and/or family." Also, in the section of "Complexity of Medical
                            > Decision Making" regarding Time: "When counseling and/or
                            coordination
                            > of care dominates (more than 50%) the physician/patient and/or
                            family
                            > encounter, then time may be considered the key or controlling
                            factor
                            > to qualify for a particular level of E/M services. This includes
                            time
                            > spend with parties who have assumed responsibility for the care of
                            > the patient or decision making whether or not they are family
                            members
                            > (eg, foster parents, person acting in locum parentis, legal
                            > guardian). The extend of counseling and/or coordination of care
                            must
                            > be documented in the medical record."
                            >
                            > I'm just wondering how to code/bill. Any help would be greatly
                            > appreciated.
                            >
                            > Thanks!
                            >
                            > Melinda Brown, CMBS
                            > Ins Biller
                            >
                            >
                            >
                            >
                            >
                            >
                            > [Non-text portions of this message have been removed]
                            >

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                          • Melinda Brown
                            Barbara, Thanks so much for providing that Medicare Manual section. That really helped me out. I printed it and saved it for later reference. The patient I
                            Message 13 of 14 , Jul 10, 2007
                            • 0 Attachment
                              Barbara,

                              Thanks so much for providing that Medicare Manual section. That really helped me out. I printed it and saved it for later reference.

                              The patient I have is BC & Dshs 2ndry. The patient is mentally retarded and her Mother came without her because she is not able to make her own decisions and she apparently didn't want to get her worked up over coming to the doctor.

                              Melinda Brown, CMBS
                              Ins Biller


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                            • B Burgess
                              As long as your BC carrier doesn t have a written policy about it, then it should be fine as it does follow CPT rules. Just be SURE the doc documents time and
                              Message 14 of 14 , Jul 10, 2007
                              • 0 Attachment
                                As long as your BC carrier doesn't have a written policy about it, then it should be fine as it does follow CPT rules. Just be SURE the doc documents time and what was discussed and he will have all the bases covered. Probably wouldn't hurt to document why the patient wasn't there as well.

                                Glad I could help !

                                Barbara Burgess, RN, CPC, ACS-EM

                                Melinda Brown <melindadocsmith@...> wrote:
                                Barbara,

                                Thanks so much for providing that Medicare Manual section. That really helped me out. I printed it and saved it for later reference.

                                The patient I have is BC & Dshs 2ndry. The patient is mentally retarded and her Mother came without her because she is not able to make her own decisions and she apparently didn't want to get her worked up over coming to the doctor.

                                Melinda Brown, CMBS
                                Ins Biller

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