tci Medicare Compliance & Reimbursement - 2019 Issue 12
Reader Question: Know the Coding Rules When the Patient Isn’t Present
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Article Overview
This reader question addresses billing a family conference or counseling visit when the patient is not physically present. It is aimed at coders, billers, and practices that need to understand how professional evaluation and management guidance, time-based reporting, and Medicare-specific policy can affect whether the encounter is billable and how it should be handled.
Why This Topic Matters
These situations arise in real-world care planning, but payer policy can differ from general CPT guidance. Understanding the distinction helps practices avoid improper billing and determine when a service may be noncovered or require separate financial arrangements.
Article Sections
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Question
A billing scenario is presented involving a family member meeting with the physician to discuss a patient’s condition, test results, and treatment considerations.
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Answer
The response contrasts general CPT guidance with Medicare policy and discusses how payer type affects whether the encounter can be reported.
What You Will Learn
- How family-only encounters are addressed in general evaluation and management guidance
- Why payer policy may change whether a visit can be billed
- How time-based reporting is discussed in relation to counseling and coordination of care
- What Medicare policy says about the patient’s presence for this type of encounter
- What considerations are mentioned for noncovered services and private payment arrangements
Who Should Read This
- Medical coders
- Medical billers
- Physician practices
- Revenue cycle staff
- Compliance staff
Codes Discussed
Code Ranges Discussed
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