Patient Not Present For OV
- 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.
Melinda Brown, CMBS
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