Stop Fretting Over Counseling Woes
Published on Thu Aug 01, 2002
Are difficult children or worried parents consuming your valuable time? When counseling consumes more than 50 percent of an office visit, you can recoup your work by coding the visit based on time. Master the Requirements and Time Frames Because the pediatrician must examine a new patient before billing for counseling, the new patient E/M codes require all three elements:
1. history
2. examination
3. medical decision-making. Established patients require only two of the elements. Therefore, the patient (child) does not need to be present for a valid established patient E/M encounter:
1. history
2. medical decision-making. For an established patient office visit, CPT Codes recommends the following time allocations:
99212 10 minutes 99213 15 minutes 99214 25 minutes 99215 40 minutes. The time parameters for new patient office visits vary slightly:
99201 10 minutes 99202 20 minutes 99203 30 minutes 99204 45 minutes 99205 60 minutes. For an established patient, if the pediatrician spends five minutes with the parent and child and 10 minutes with the child, for a total of 15 minutes, you should report 99213 (Office or outpatient visit for the evaluation and management of an established patient, which requires at least two of these three components: an expanded problem-focused history; an expanded problem-focused examination; medical decision-making of low complexity physicians typically spend 15 minutes face-to-face with the patient and/or family).
Parents,Guardians Qualify for Time Criteria Sometimes, a pediatrician needs to spend more time with the parents than with the child. For example, the parents may not discipline effectively or may have inappropriate expectations. The pediatrician deserves reimbursement for educating and counseling parents by billing the E/M code, says Richard H. Tuck, MD, FAAP, member of the American Academy of Pediatrics national committee on coding and nomenclature. CPT allows the use of E/M codes for counseling an established patient's parent, Tuck says. When counseling consumes more than 50 percent of "the physician/patient and/or family encounter," the physician can use time as the key factor in selecting a level of E/M code, according to CPT's E/M services introduction. If the person is legally responsible for the patient's care, even if he or she is not a family member, e.g., "foster parents, person acting in locum parentis, legal guardian," you can bill for the time, CPT Assistant November 1999 explains. Beware of Diagnosis Pitfalls When selecting a diagnosis for the counseling, you should consider three issues:
1. The payer might not pay for a 300-series code, e.g., 300.9 (Neurotic disorders; unspecified neurotic disorder), 305.20 (Nondependent abuse of drugs; cannabis abuse; unspecified) and 309.0 (Adjustment reaction; brief [...]
