Is it appropriate to report an office visit code ( 99211 - 99215 ) when the patient is not present? For example, the family of a stroke patient comes in to discuss the patients care with the physician, while the patient is left at home. This is assuming the physician wants to report the E/M service based on time with non-face-to-face patient contact. ...
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Article Overview
This Find-A-Code article discusses CPT evaluation and management guidance for office and other outpatient visits when the patient is not present, including situations involving family members or other parties involved in care discussions. It is relevant to coders, billers, and compliance staff who need to understand how the 2013 CPT Professional Edition frames face-to-face time and time-based reporting for these services. The article also notes documentation expectations and the possibility that payer policies may differ from CPT guidance.
Why This Topic Matters
Understanding how office and outpatient E/M services are discussed in CPT when the patient is absent helps support more accurate documentation review and code selection. It is especially useful in cases involving counseling, coordination of care, and visits with family or other decision-making parties.
What You Will Learn
- How CPT frames face-to-face time for office and outpatient E/M services
- When time may be considered the key factor in an E/M service
- What kinds of encounters may involve family members or caregivers
- Why documentation of counseling and coordination of care matters
- How payer policies may differ from CPT guidance
Who Should Read This
- Medical coders
- Medical billers
- Compliance staff
- Physician practices
- Revenue cycle professionals
Codes Discussed
Code Ranges Discussed
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