Forum - Questions & Answers

Sep 20th, 2011 - Shannan 28 

Consult

I have a pt who came in to consult with the doctor regarding her husband having a stroke and how to help her cope. How do I code that? Dr spent quite a bit of time with her. Would a 99242 be appropriate and what diagnosis would I use? Any advise would be appreciated. Her insurance is Medicare.

0 Votes - Sign in to vote or reply.
Sep 23rd, 2011 - slackcoder 55 

re: Consult

I would suggesting billing by time counseling /coordination of care. I hope your Doctor wrote down the time and that over 50% of the time spent with her was counseling regarding coping skills etc. V61.49 for diagnosis.

0 Votes - Sign in to vote or reply.
Sep 23rd, 2011 - jschmutz   323 

re: Consult

Medicare: "When counseling and/or coordination of care dominates (more than 50%) the outpatient/office face-to-face physician/patient encounter or the inpatient floor/unit time, time is the key or controlling factor in selecting the level of E&M service."

CPT: "When counseling and/or coordination of care dominates (more than 50%) the physician/patient and/or family encounter (face-to-face in the office or outpatient setting or floor/unit time in the hospital or NF), then time may be considered the key or controlling factor to qualify for a particular level of E&M service. This includes time spent with parties who have assumed responsibility for the care of the patient or decision making whether or not they are family members."

0 Votes - Sign in to vote or reply.
Oct 31st, 2011 - ajeeshkk 1 

re: Consult

Consultation codes are not billable for medicare. Use office visit codes instead.

0 Votes - Sign in to vote or reply.
Oct 31st, 2011 -

re: Consult

Wait a minute; who was the patient? Are you asking about billing in the husband's insurance or the wife's? For her it sounds like situational depression. you can't bill the husband's insurance if he is not present.

0 Votes - Sign in to vote or reply.
Nov 3rd, 2011 - Codapedia Editor 1,399 

re: Consult

Signaturedoc is correct: if a Medicare patient the beneficiary must be present in order to bill.

There is an article in Codapedia and extensive forum discussions about this topic. Search "family" and you'll find discussions about visits without the patient present.

0 Votes - Sign in to vote or reply.


About Codapedia by InnoviHealth Systems Contact Us Terms of Use Privacy Policy Advertise with Us

Codapedia™ by InnoviHealth Systems™ - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain) - Fax (801) 770-4428

Copyright © 2009-2019 Find A Code, LLC - CPT® copyright American Medical Association