Q&A ? on a new patient consultation with family and patient not present.

[Nancy Mash]

I work in a Outpatient Cancer Center Facility and have a question on a new patient E&M visit. We have a new patient that scheduled a Second Opinion/New patient consultation appt. Patient's family came into the office without the patient for second opinion regarding his disease management. The patient was too ill to come into the appointment. Do you know if there is a New Patient E&M visit that we can bill? The visit was more than 30 minutes with more than 50% of the time in counseling.

 

[LyndaH]

Did the patient/family members request the consultation? A consultation would need to be initiated by a physician or other appropriate source according the E/M guidelines (2012) maybe things have changed? I'm waiting on my 2013 books

 

[LyndaH]

Oops, I meant to say a consultation code, the guidelines say you can use an office visit code See page 18 on E/M guidelines. I hope this helps. If I'm wrong, I'm sure someone will chime in

 

[Nancy Mash]

The patient/family requested a second opinion. Patient has Medicare and we cannot bill consultation code since they do not recognize these codes any longer.

 

[Nancy Mash]

The patient/family requested a second opinion. Patient has Medicare and we cannot bill consultation code since they do not recognize these codes any longer.

 

[Nancy Mash]

Can we bill the E&M even if the patient was not present at the visit?

 

[LyndaH]

I think this might be better answered from Laureen, as I'm not familiar with Medicare, however, for example code 99203 New patient states Counseling and/or coordination of care with the patient/and or family. "Usually, the presenting problems are of moderate severity. Physicians typically spend 30 minutes face-to-face with the patient and/or family. This is my understanding, but don't quote me on it because I'm just not that familiar with Medicare.

 

[Ruth Sheets]

Laureen covered this in the May 2013 Q&A Webinar. Here is a video of her answer.
https://www.youtube.com/watch?v=bqqRf2FYQ-o