Wiki Billing Based on Time

Create Wiki
R

renifejn

Guru
Messages
208
Location
Bolingbrook, IL
Best answers
0
Absolute Brain Fart time here


established office visit

60 min spent face to face with patient
20 min spent in counseling

Because only 40 min are needed for 99215, do I use 99215? Or do I level the documentation (213 in this case) and add prolonged services to it?
 
Here is some info from our FI. This is right from their billing guidelines for E&M form New England hope this hope this helps



Counseling and/or Coordination of Care (Time-Based)
When an E/M service is dominated by counseling and/or coordination of care (the counseling
and/or coordination of care represents more than 50% of the total time with the patient) in a faceto-
face encounter between the physician or NPP and the patient in the office/clinic or the floor
time (in the scenario of an inpatient service), then the E/M code is selected based on the
typical/average time associated with the code levels. The time approximation must meet or
exceed the specific CPT code billed (determined by the typical/average time associated with the
E/M code) and should not be “rounded” to the next higher level. In those E/M services in which
the code level is selected based on time, prolonged services may only be reported with the
highest code level in that family of codes as the companion code.
Good luck

Robin Ingalls-Fitzgerald CCS, CPC, FCS, CEMC
 
renifejn said:
Absolute Brain Fart time here


established office visit

60 min spent face to face with patient
20 min spent in counseling

Because only 40 min are needed for 99215, do I use 99215? Or do I level the documentation (213 in this case) and add prolonged services to it?
Click to expand...

You pose a good question! In my opinion and from what I am reading from my local Medicare carrier it states that "If the physician documents total time and suggest that counseling or cc dominates more than 50% of the encounter, time may determine the level of service.

And according to what you have documented I don't think you'd bill a 99215 because 20 minutes is not 50% of the total visit. I understand where your coming from with the 40 minutes comment but those are just "estimates of time".

If your physician would have stated that 60 minutes was the total time and 30 minutes was counseling or CC then yes I would bill a level five.
 
What was the counseling about? Could you possibly support the 99213 and 99401?

Just a thought,

Laura, CPC
 
Since time did not dominate the visit, it would not be appropriate to code the service based solely on time (if time did dominate the total visit, you would use only the 99215 because the additional 20 minutes would not be enough to add on prolonged care). You would code this visit according to the key elements documented; or 99213 per your review. Since a 99213 average time is 15 minutes, then that does leave the remaining time spent - 45 minutes - to account for and bill. In this case, I would agree that yes, prolonged care would be the appropriate code to use in addition to the 99213 because what was provided was beyond the service usually provided for that level of E/M. Because the additional time was more than 30 minutes but not over 74 minutes, the prolonged care code would be 99354.

"Not everything that counts can be counted, and not everything that can be counted counts". ~ Albert Einstein

Barbara Burgess, RN, CPC, ACS-EM, PCS
 
Last edited:
Prolonged

You would code the level of service as documented per the key elements (history, exam, MDM). Then you would figure out how much MORE time was spent than typical for that level of service, and if the remainder is at least 30 minutes you would use the appropriate prolonged service code.

The reason you cannot bill based on counseling/coordination of care time is that your time spent in counseling is not more than 50% of the total time spent face to face with the patient.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
You must log in or register to reply here.
Top