Part B News

February 12, 2018

Vol 32 Issue 7

Question: We had a patient walk out of an encounter before the doctor could complete her exam. Is there any way to bill for this?

Answer: Probably not — unless the encounter ends for a medical reason at your direction. “Some patients leave because the wait is too long or they have an emergency while sitting in the waiting room or they simply change their mind,” says Terry Fletcher, CPC, president of Terry Fletcher Consulting in Laguna Beach, Calif., and host of the CodeCast Medical Billing podcast. “If we are talking E/M service, if the patient doesn’t make it to the exam room, it would be hard to justify charging them a fee — since there was no face-toface encounter with the physician.”

That is true even if you started services before the patient left, says Valerie Fernandez, MBA, CCS, CPC, CIC, CPMA, manager of coding client program development for H.I.M. ON CALL Inc. in Allentown, Pa. “When a patient ‘elopes,’ no services are billed despite any triage that may have occurred,” says Fernandez.

What about any copay you may have taken at the front desk? “Since that is an office visit copay,” you have to give it back, says Fletcher.

If you had the presence of mind to have the patient sign off on policies and procedures that require a payment if the patient walks out, you can bill the patient — not the payer — for that abandoned appointment, says Andrew Selesnick of the Buchalter law firm in Los Angeles.

It’s similar to a no-show policy, says Selesnick: “That’s a non-covered service. But you can bill the patient if you have a policy in place — something like ‘If you don’t show up or leave early, we can charge.’”

This policy charge must apply equally to all patients to avoid charges of preferential or prejudicial treatment. Also, you have to have a signed statement of patient consent. You might require new patients to sign off on that when they make their appointments, perhaps by checking a box in your online appointment tool, so you can charge them for a no-show as well.

If you collected the copay and you have a broken appointment, you can use that money toward your
payment, even though you originally took it as a copay, says Selesnick. Make that clear in your billing documentation and notify the patient.

Document, bill when patient goes to ER

And then there’s the encounter that terminates because the provider sees a patient who needs to get to
the emergency room.

“Document it,” says Selesnick. “You’re doing something even if you’re just taking care of them when
they collapse. The reality is, you’ve provided services. The medical decision-making is go to the hospital. I have never seen anyone challenge that.”

“At our practice, if someone is sent to the hospital or we have to call 911, depending on how far along we were with the visit, we may or may not bill an appropriate level E/M code based on the documentation,” says Manny Oliverez, CEO of Capture Billing & Consulting Inc., South Riding, Va.

Bill for “whatever you document,” says Selesnick. “You did see the patient face to face. You used MDM [medical decision-making] in considering what to do with them. You got the HPI [history of present illness], as much as you could. If the encounter was just a few minutes, maybe it’s not a level 5, but whatever you document you can bill.”

Also, if the practice physician accompanies the patient as the admitting doctor at the hospital, you can bill for that, says Fletcher. But “if they admitted the patient to the hospital under a hospitalist, then [the original provider] would get a lower level new patient visit based on what was completed.” — Roy Edroso (redroso@decisionhealth.com)

Used by permission of Part B News