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E/M CODES VS. CONSULT CODES

Bernadette Posted Mon 29th of July, 2013 16:57:42 PM

Hello,

A parent comes in the office without the patient to speak with one of our pediatricians about her child. This is an established patient of the office who has been having some eating disorder issues. The pediatrician and the parent meet face to face and discuss the issues for 30 minutes. Again, the patient is not present and there is no examination of the patient. Would a consult code 99242 be appropriate to bill to the insurance for this visit? Or should 99214 be billed? The patient has commercial insurance ... We hope you would be able to clarify this information.

Thanks for your input!

SuperCoder Answered Thu 01st of August, 2013 13:00:03 PM

You should report a code from the 99212-99215 series based on time spent counseling and coordinating the patient’s care. As the descriptor for these E/M codes says, the visits in this category can involve time “with the patient and/or family.”

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