Wiki Established patient E&M coding when patient not present

Can we bill an established patient E&M when the encounter only has a family member and the patient was not present? I watched a coding podcast from a Terry Fletcher where she says we cannot anymore, but when I read at the beginning of the E&M guidelines it does state that "these guidelines are for services that require a face to face encounter with the patient and/or family/caregiver." I am looking for clarification as we currently have a scenario where the patient was not present, only the mother of the patient.

Unless there is an upcoming change I haven’t read about yet, the most recent resources from AMA and CMS do not specify that the patient must be present with the family/caregiver in order for the provider to get credit for the visit.

—
Ryan Stroup, CPC

I just listened to the podcast as well. At first, I thought she was correct, because the 2023 code descriptions of the individual codes (99212-99215) did remove the specific verbiage of "patient and/or family memeber/caregiver". However, when I go back to the Overall instructions for the E&M section in the code book, it does say:
"
The E/M guidelines have sections that are common to all E/M categories and sections that are category specific. Most of the categories and many of the subcategories of service have special guidelines or instructions unique to that category or subcategory. Where these are indicated, eg, "Hospital Inpatient and Observation Care," special instructions are presented before the listing of the specific E/M services codes. It is important to review the instructions for each category or subcategory. These guidelines are to be used by the reporting physician or other qualified health care professional to select the appropriate level of service. These guidelines do not establish documentation requirements or standards of care. The main purpose of documentation is to support care of the patient by current and future health care team(s). These guidelines are for services that require a face-to-face encounter with the patient and/or family/caregiver. (For 99211 and 99281, the face-to-face services may be performed by clinical staff.)

In the Evaluation and Management section (99202-99499), there are many code categories. Each category may have specific guidelines, or the codes may include specific details. These E/M guidelines are written for the following categories:

Office or Other Outpatient Services

Hospital Inpatient and Observation Care Services

Consultations

Emergency Department Services

Nursing Facility Services

Home or Residence Services

Prolonged Service With or Without Direct Patient Contact on the Date of an Evaluation and Management Service


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