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Family Practice Coding Alert

You Be the Coder: Counseling a Family Member


- Published on Thu, Aug 01, 2002
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: A mother brought her daughter in for a well-child exam. After the visit, the FP spent 20 minutes speaking with the mother about her son's recently diagnosed seizure disorder. The son was not present. Should we bill this service to the mother or the son?

Wisconsin Subscriber

 

       

Answer: Bill the conversation as a service to the mother because she is receiving counseling about her son. CPT defines counseling as a discussion with a patient and/or family concerning one or more of the following areas:

  • Diagnostic results, impressions, and/or recommended diagnostic studies
  • Prognosis
  • Risks and benefits of management (treatment) options
  • Instructions for management (treatment) and/or follow-up
  • Importance of compliance with chosen management (treatment) options
  • Risk-factor reduction
  • Patient and family education.

    When counseling and/or coordination of care dominates more than 50 percent of the visit, you can consider time the controlling factor for the level of E/M service. In your case, the FP counseled the mother for 20 minutes regarding her son's condition. To account for the time, report 99213 (Office or other outpatient visit for the evaluation and management of an established patient; counseling and coordination of care with other providers or agencies are provided consistent with the nature of the problem[s] and the patient's and/or family's needs ... Physicians typically spend 15 minutes face-to-face with the patient and/or family).

    Use a diagnosis code such as V61.49 (Health problems within family; other) for the care of a sick person in a family or household. Code V65.1 (Other persons seeking consultation without complaint or sickness; person consulting on behalf of another person), which includes advice or treatment for a nonattending third party, may also be appropriate.




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