tci General Surgery Coding Alert - 2004 Issue 6

Reader Question: Don't Expect Payment if Patient Isn't Present

Question: Can we bill an office visit (99211-99215) for a consult with a family member to discuss a patient's condition if the patient is not present? North Carolina Subscriber Answer: More than likely, you cannot receive reimbursement from Medicare for discussions with a family member about a patient's condition if the patient is not present. Medicare requirements specify that the physician must meet face-to-face with the patient to report an established patient E/M visit (99211-99215). The only exception is if the physician must contact another individual (such as a spouse, parent, child or other family member) to "secure background...

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