lnbrock
New
Since the change in 2021 where you can now code by MDM or Time I am coming across some concerning things while auditing. I know that when the provider chooses the E/M level based on MDM that time is not supposed to be a factor but I am seeing a trend of providers billing over 95% level 4 visits and seeing 30 plus patients a day at that level but is only physically in the office 5-6 hours a day plus performing procedures in-between all of these office visits. These providers are also documenting a 14 system exam on all of these patients. I don't see how there is enough time to physically see 30 patients a day, document a full History, full ROS, and 14 system exam AND the time it takes to complete the MDM in 5-6 hours a day. Is there documentation somewhere that discusses billing for more "time" than you are physically in the office in a day for me to use when I speak to these providers? I think the OIG is actually looking into this very scenario and want to educate my providers. Thank you in advance for your help and have a great day!