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Patient Not Present For OV

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  • Melinda
    Q Can I ever bill an E&M code if I am working with the patient s family and the patient is not present? A This depends on the payer. The CPT manual states as
    Message 1 of 1 , Jun 8, 2009
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      Q Can I ever bill an E&M code if I am working with the patient's
      family and the patient is not present?

      A This depends on the payer. The CPT manual states as part of the code
      description for most of the outpatient visit codes that a certain amount
      of time is spent face-to-face with the patient and/or family.

      This language is intended to reference coding by time. In the inpatient
      codes the language points to "floor time," and the definitions
      in the E&M guidance section make it clear that time spent talking with
      the patient's family can be included in these times.

      But the troublesome application here (and the one likely related to your
      question) is 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. Make it clear to caregivers or relatives in advance
      that the visit will be on a cash basis.

      www.PhysiciansPractice.com <http://www.physicianspractice.com/>

      Melinda Brown, CMBS

      Ins Biller



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