decisionhealth Newsletters, Part B News - 2021 Issue 9 (September)
Streaming a family update via Zoom? Don’t bill as an office visit
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Article Overview
This article addresses a Medicare billing question involving a physician’s Zoom conversation with a patient’s adult daughter when the patient was not present. It explains the general treatment of family-member conversations under office-visit E/M billing, including how telehealth-era flexibilities and newer E/M guidelines relate to time-based and medical-decision-making approaches. The article is aimed at coders, billers, and clinicians who need to understand when remote communication may or may not support an office visit.
Why This Topic Matters
Remote communication with family members is common in practice, but it does not automatically qualify for E/M billing. Understanding the boundary between permissible supporting communication and billable office-visit services helps prevent improper Medicare claims.
What You Will Learn
- How Medicare treats family-member conversations in relation to office-visit billing
- How telehealth-related exceptions interact with standard E/M requirements
- How time-based and MDM-based approaches differ for incorporating family or historian communication
- What general categories of communication may be considered in E/M review
Who Should Read This
- Medical coders
- Medical billers
- Physicians
- Practice managers
- Compliance staff
Codes Discussed
Code Ranges Discussed
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