tci General Surgery Coding Alert - 2005 Issue 9

READER QUESTIONS: Insurers Won't Pay for Family Counseling

Question: Is there any way we can charge for a visit to discuss a patient's situation if the patient isn't present? The CPT descriptors for established patient E/M codes do specify, "the physician typically spends X minutes face-to-face with the patient and/or family" [emphasis added].Nevada Subscriber Answer: Regardless of the phrasing in CPT, most insurers, including Medicare, will not reimburse for any E/M service - even those strictly concerned with counseling or coordination of care - if the patient is not present. Simply put, without face-to-face time with the patient, you haven't got a billable service.The only...

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