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Question: A patient鈥檚 family came in, and our pediatrician spoke to them about the child鈥檚 diagnosis and made a plan with the family. Can this be billed if the child was not present due to the child鈥檚 age and diagnosis?

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Answer: Yes, it is perfectly possible to bill for an appropriate level of office/outpatient evaluation and management (E/M) service in situations like this.

That鈥檚 because CPT^庐 defines total time for office/outpatient evaluation and management (E/M) services as including 鈥渃ounseling and educating the patient/family/caregiver.鈥� Under this situation, family counseling without the patient would qualify.

Further, CPT^庐鈥檚 Counseling Guidelines state that 鈥渃ounseling is a discussion with a patient and/or family,鈥� (emphasis added). The 鈥渙r鈥� here can be taken to mean that the patient does not have to be present.

However, some payers may interpret these guidelines differently, and may insist that the patient be present during the encounter for you to be reimbursed for the office/outpatient E/M service. So, you should verify a specific payer鈥檚 policy before billing.