Question 2021 E & M Coding for time

cyates

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When time is used to code your E & M do you have to break it down as to time with patient, time reviewing records or time documenting? Everything that I see just says "total time" but a webinar through Waystar said to break it down in case you are audited. That would be so time consuming which is what they are trying to control.
 

csperoni

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I have not seen any guidance from official sources stating the time must be broken down, or start/stop times required.
I have seen opinions stating it's recommended for the exact reason of an audit. I believe these opinions are given by attorneys and not by anyone involved in actual patient care.
In the real world, how could you possibly have accurate start/stop times, particularly when it could be sporadic throughout the day?
The entire point of the 2021 outpatient E/M changes is to reduce administrative burden, and focus on patient care over paperwork. If my physician would need to document for every patient:
8:51a-8:57a reviewed CT report from 12/10/2020
8:57a-8:59a started EHR documentation
1:23p-1:48p face to face patient care
1:52p-1:58p completed EHR documentation
Instead of a radio button "Total time spent today on visit ______ minutes" just filling in the 39, we would have to see 20% fewer patients than we do now.
I just think you need to be aware of looking at the big picture.
For example, if you schedule patients every 30 minutes, over a 7 hour period, and the clinician spends an hour pre-office hours and an hour post-office hours, then stating 39 minutes in the above example is very reasonable and could be defended.
If you schedule patients every 10 minutes over an 8 hour period, and every patient states 25+ minutes, that would be highly suspect as it means the physician performed 20+ hours of work that day.

My personal take on MDM vs time for 2021 is not all that different than it is pre-2021. Most physicians, most specialties, most visits, MDM is probably the way to go. Certain specialties, or certain time consuming patients should have time documented and bill as time. An efficient clinician, with well-trained competent staff can usually meet MDM requirements quicker than time requirements.
 

Cheezum51

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I've seen several sources say that you DO NOT have to detail the components of the total time and just have to note something like, "Total time for visit was xx minutes"

One thing you have to consider in choosing whether to use time versus MDM is that for certain visits, such as a progress check, it may be easier to choose time. However, if you consider the MDM elements, it may actually qualify for a higher paying code.
 

lcolborn

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You do not need to itemize, but it is advisable to show what activities took place during the visit. It is really time consuming to mark all that was done, but you can just make a constructive statement on what took place etc. with the total time. You still have to show medical necessity, and if needed more time, there's the prolonged services that we can use.
 

estertov

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Hello everyone, New to the forum. Have seen so much great info posted!
I am still confused with the the new E/M codes and prolonged service code G2212
USDOL has come back denying the code for prolonged services. Does anyone have any information on the new 99417 and G2212 CPT codes?
Greatly appreciated
 

csperoni

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Hello everyone, New to the forum. Have seen so much great info posted!
I am still confused with the the new E/M codes and prolonged service code G2212
USDOL has come back denying the code for prolonged services. Does anyone have any information on the new 99417 and G2212 CPT codes?
Greatly appreciated
I believe USDOL is for worker's comp, which I have zero personal experience with. When I did dabble in workers comp (almost 20 years ago), there were some unique rules to workers comp that did not follow standard coding guidelines.
1) What is the reason for the denial?
2) For information about 99417 from AMA https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf
3) For information about G2212 from Medicare https://www.cms.gov/files/document/r10505cp.pdf
Rule #1 for prolonged services is that you must already be billing the highest level. You cannot bill prolonged with anything other than level 5. The time thresholds for 99417 and G2212 differ. The codes are not interchangeable based solely on the carrier.
Just because a code exists does not mean it is covered by a carrier.
Hope some of that helps, and perhaps someone with WC knowledge can also assist.
 

estertov

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I believe USDOL is for worker's comp, which I have zero personal experience with. When I did dabble in workers comp (almost 20 years ago), there were some unique rules to workers comp that did not follow standard coding guidelines.
1) What is the reason for the denial?
2) For information about 99417 from AMA https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf
3) For information about G2212 from Medicare https://www.cms.gov/files/document/r10505cp.pdf
Rule #1 for prolonged services is that you must already be billing the highest level. You cannot bill prolonged with anything other than level 5. The time thresholds for 99417 and G2212 differ. The codes are not interchangeable based solely on the carrier.
Just because a code exists does not mean it is covered by a carrier.
Hope some of that helps, and perhaps someone with WC knowledge can also assist.
Thank you for the information. I was under the impression that only medicare would use G2212 and all other carries 99417. USDOL denied 99417 saying its a non payable code.
 

SharonCollachi

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Thank you for the information. I was under the impression that only medicare would use G2212 and all other carries 99417. USDOL denied 99417 saying its a non payable code.
USDOL follows Medicare guidance. I haven't had to use prolonged services for any of our USDOL patients yet, so I don't know what they're paying.
 
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