AMA CPT® Assistant - 2013 Issue 3 (March)
Evaluation and Management (Q&A) (March 2013)
March 2013 page 13 Evaluation and Management Question: 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 patient's 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. Answer: Yes. The evaluation and management (E/M) services guidelines on page 8 of the 2013 CPT Professional Edition codebook state, "Face-to-face time (office and other outpatient visits and...
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Article Overview
This article addresses a March 2013 evaluation and management coding question from CPT Assistant. It explains the general scope of the guidance on office and other outpatient E/M reporting, with emphasis on how time, counseling, and coordination of care are discussed in relation to encounters involving family members or others acting for the patient. It is useful for coders, billers, and clinicians who need to understand the article’s coverage before reading the full guidance.
Why This Topic Matters
E/M reporting can depend on how the encounter is counted and documented, especially when the patient is not physically present. This article is relevant for professionals trying to understand the CPT perspective on time-based E/M documentation in these situations.
Article Sections
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Evaluation and Management
Introduces a coding question about office and outpatient evaluation and management reporting when the patient is not present. The section focuses on the general topic of time-based service reporting and documentation.
What You Will Learn
- How this CPT Assistant Q&A frames an E/M reporting question involving family discussion.
- The general documentation themes emphasized for time-based evaluation and management services.
- The scope of the article’s guidance for office and outpatient E/M topics.
- intended_audiences":["Medical coders","Billing staff","Physicians","Compliance staff"],
Who Should Read This
- Medical coders
- Billing staff
- Physicians
- Compliance staff
Codes Discussed
Code Ranges Discussed
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