Fee Navigator®

    Billing tip: Family conferences 03.05JB

    Family conferences that are formal, scheduled conferences discussing the patient without the patient present may be claimed using 03.05JB. Claims should be submitted using the PHN of the patient that is being discussed.

    When a patient has a chaperone such as a family member(s) or spouse with him/her at the visit, this may not be claimed using 03.05JB. Visits that include a chaperone should be claimed using the most appropriate visit code(03.02A, 03.03A, 03.04A).

    Complex modifiers can be added to the claim as appropriate for any additional time spent managing the patient's care and communicating with the chaperone if required.

    03.05JB - Formal, scheduled family conference relating to a specific patient, per 15 minutes or major portion thereof

    03.05JB may be claimed at the same encounter as a patient visit if:

    • The visit service for the patient has ended and the chaperone requests additional time with the physician to discuss the patient.
    • When claiming one call, the greater portion of 15 minutes must be spent discussing the patients care with the chaperone. As per GR 2.3.5, additional calls may not be claimed until the full amount of time described in the HSC for each previous call has elapsed.
    • Clear documentation that the visit service has ended and the family conference was related to, but not part of, the original visit service must be recorded in the patient’s record.
    • Claims for other services for concurrent time may not be submitted. For example: complex modifiers on the visit service (CMXV/CMGP/CMXC) may not be submitted for the same time period that a claim for 03.05JB is submitted.