Can an evaluation and management visit be billed without the provider seeing the patient?
Face-to-face time is an inherent component to evaluation and management visits. Even though some E&M codes require only two of three components for the level of service billed, this does not remove the requirement that patient contact by the billing provider must be made and documented. For example, CIGNA Government Services has seen instances where the provider billing an E&M visit (i.e. 99232-subsequent hospital care) reviewed only the hospital record then summarized a history of present illness and rendered complex decision-making via new or revised orders without ever seeing the patient. The components of E&M codes and, subsequently, the level of service billed require the billing provider’s performance of these components by way of his or her direct contact with the patient. Services performed by the staff of a hospital cannot be counted towards the level of service billed by the physician. This guideline would not be limited to subsequent hospital visits but would also extend to
Face-to-face time is an inherent component to evaluation and management visits. Even though some E&M codes require only two of three components for the level of service billed, this does not remove the requirement that patient contact by the billing provider must be made and documented. For example, CIGNA Government Services has seen instances where the provider billing an E&M visit (i.e. 99232-subsequent hospital care) reviewed only the hospital record then summarized a history of present illness and rendered complex decision-making via new or revised orders without ever seeing the patient. The components of E&M codes and, subsequently, the level of service billed require the billing provider’s performance of these components by way of his or her direct contact with the patient. Services performed by the staff of a hospital cannot be counted towards the level of service billed by the physician. This guideline would not be limited to subsequent hospital visits but would also extend to
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- Can an evaluation and management visit be billed without the provider seeing the patient?
