Advanced Care Planning-We use time


Fridley, MN
Best answers
We use time based billing in our office. Does this make us exempt from using a CPT code and advanced care planning code together? IE: (We see nursing home patients) 99310 and 99497 is what's I'd like to use together - with all the proper documentation. If we are billing based off time can I use both codes?
Jblm, WA
Best answers
Counseling and Coordination of Care Visits
With the reestablishment of typical/average time units, medically necessary E/M visits for counseling and coordination of care, for Nursing Facility Services in the code ranges
(99304 - 99306, 99307 - 99310 and 99318) that are time-based services, may be billed with the appropriate prolonged services codes (99356 and 99357).

G. Multiple Visits
The complexity level of an E/M visit and the CPT code billed must be a covered and
medically necessary visit for each patient (refer to §§1862 (a)(1)(A) of the Act). Claims for an unreasonable number of daily E/M visits by the same physician to multiple patients at a facility within a 24-hour period may result in medical review to determine medical necessity for the visits. The E/M visit (Nursing Facility Services) represents a “per day” service per patient as defined by the CPT code. The medical record must be personally documented by the physician or qualified NPP who performed the E/M visit and the documentation shall support the specific level of E/M visit to each individual patient.

When counseling and/or coordination of care dominates (more than 50 percent of) the physician/patient and/or family encounter (face-to-face time in the office or other outpatient setting, floor/unit time in the hospital, or NF), time is considered the key or controlling factor to qualify for a particular level of E/M services. If the level of service is reported based on counseling and/or coordination of care, the total length of time of the encounter should be documented and the record should describe the counseling and/or activities to coordinate care.

CPT Guidelines state:

Intraservice times are defined as face-to-face time for office and other outpatient visits and as unit/floor time for hospital and other inpatient visits. This distinction is necessary because most of the work of typical office visits takes place during the face-to-face time with the patient, while most of the work of typical hospital visits takes
place during the time spent on the patient’s floor or unit. When prolonged time occurs in either the office or the inpatient areas, the appropriate add-on code should be

Face-to-face time (office and other outpatient visits and office consultations): For coding purposes, face-toface time for these services is defined as only that time spent face-to-face with the patient and/or family. This includes the time spent performing such tasks as obtaining a history, examination, and counseling the patient.

Time is also spent doing work before or after the face-toface time with the patient, performing such tasks as reviewing records and tests, arranging for further services, and communicating further with other professionals and the patient through written reports and telephone contact. This non-face-to-face time for office services—also
called pre- and postencounter time—is not included in the time component described in the E/M codes. However, the pre- and post-non-face-to-face work associated with an encounter was included in calculating the total work of typical services in physician surveys. Thus, the face-to-face time associated with the services described by any E/M code is a valid proxy for the total work done before, during, and after the visit.

99310 - Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components:
A comprehensive interval history; A comprehensive examination; Medical decision making of high complexity.

Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Typically, 35 minutes are spent at the bedside and on the patient's facility floor or unit. - the provider performs subsequent nursing facility care for a patient. The provider spends an average of 35 minutes face to face with the patient and on the unit or floor.

Time-based Billing
• Although most codes are selected based on the three key elements of history, examination,
and medical decision-making, in certain cases, time-based billing (ie, billing on the length of
the visit) can be used.
• Visits must be dominated by counseling or coordination of care.
• Time is defined as face-to-face time for out-patients or floor/unit time for in-patients.
• Three things must be documented: the total duration of the visit, that at least 50% of the time
was spent on counseling or coordination of care, and the issues that were discussed

• For visits that are not dominated by counseling or coordination of care, billing cannot be based on
time; however, time may still be a useful preliminary indicator of appropriate code selection

99497 - In this procedure, the provider discusses and shares planning with a patient, his family, or an individual representing the patient, regarding the future health care needs of the patient. Use this code for the first 30 minutes of face to face time that the provider spends.
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