Billing Child's Insurance for a Parental Visit

[barb2512]

I have taken a new counselor/client and she says she only bills for whomever is sitting in the session. So if a parent comes in for the first appointment to meet the counselor and lay out the situation that is bringing the child in, the counselor bills the parents (or the parent's insurance) for that visit.

I have been billing mental health since 1996 and this is a first for me. And today I get a call from a parent that said she expected the visit to be billed under her son's insurance. She did give me her insurance info to check her benefits. But she never heard the counselor explaining that she was liable for the visit. She said she didn't remember hearing that.

I will talk to the counselor about it. I think it will be a continuing confusion if she sees a lot of children.

But I feel a bit unsure how to present the case that when the parent's visit is all about the child, it can be billed under the child's insurance.

Any thoughts are appreciated.

Barbara

[kristin]

Let me preface this by saying I don't know mental health billing at all, have no experience with it.

That said, I do know that you bill the insurance provided listing the patient as the patient, and the insured as the insured. So if the parent is not the patient, but the insured, their name should not go on the CMS-1500 as the patient, they would be listed as the insured only.

If the provider is seeing the parent first, before they see the child, who WILL be the patient, then it may not be an insurance billable situation, it may be self-pay, but I don't know for sure...it just doesn't seem right to bill the parent's insurance, listing them as the "patient" for that first meeting if they are not the actual "patient".  Anyone else have some insight?

Additionally, if Medicare is the insurance, you absolutely cannot bill for visits with family, only for visits with the patient.

[Michele]

There is a code (which I'm sure you're aware of) for seeing the patient's family members without the patient present.  If the counselor is seeing the parents only, (the patient does not come in on that first visit at all) strictly for the purpose of getting information about the child, that is probably the most accurate code.  90846.  I would be curious what diagnosis she is using since the parents are not the ones being treated.  For example if they are seeing a child for ADD or ADHD and getting the info from the parents, are they using ADD as the diagnosis?  The parents don't have ADD. 

[PMRNC]

Michele is correct, the parents are not patients, and if they are being seen without the child that would be 90846 and is billed under the child. 90847 would be billed if the child was in with the parents. The diagnosis of the child is used in either scenario.

Now there are SOME circumstances where billing under parents would be appropriate, I have a client who sees families court ordered where one or more of the parents are considered patients as well.

[rdmoore2003]

You totally have to check the patients benefits.  You file for the patient.  This counselor needs to be informed better.   Counselor needs to look at descriptions, at least, for each code.  Common sense should tell them that you file under the patient's insurance not someone else's.   I know that common sense isn't used in medical field but come on, thats like my neighbor getting billed for my water usage at home.

[barb2512]

Thank you all!!

Barbara