Billing a PE and E&M (based on time)

[edezarik]

I work for Primary Care Physicians. We have a physician that sees a patient for their PE visit and then when they are also billing an E&M for acute or chronic conditions where they have changed a medication, have new problem, added a new medication etc... instead of billing the E&M on MDM, they are documenting "Time" they spent on each of those conditions and when it adds up to 40 minutes, they want to bill a Level 5 with the PE code. The Level 5 is only based on the time and not MDM. I have not found clear guidelines that a Dr can not bill an E&M along with a PE based on "Time" if they clearly document the time spent on those Acute or Chronic conditions. Does anyone have more information.

 

[Pam Warren]

Since CPT does not assign a time for a PE, you cannot bill a PE based on time alone. You can bill the E&M based on time, but there needs to be a statement that validates that none of the time spent on the E&M was performing any work on the well visit. Separate notes are generally suggested.

 

[edezarik]

Ok, Thank you for replying. I knew the PE did not have a time associated with it. The Dr will document for example: 25 minutes were spent on the annual physical, including age-appropriate screening review, immunizations, and preventive counseling. An additional 45 minutes were spent on the date of the service, including chart review, patient evaluation, documentation and care coordination for non preventive aspects of the visit, which include management of HLD (10min), HH (10Min), hx of mild TR(10 min), osteopenia (5min), hx of colon polyps (5min) and evaluation of easy bruising (5min). This is at the summary of the A&P. What is your thought on this?