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Wiki Changing Time Documented To Add More Codes

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dschlaefli

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Hello,
I am in a questionable situation and would like to understand others opinions.
If a provider documents they spent 10 mins with the patient, but want to bill out a 99497 which requires 30 mins documented time. If the provider goes back and changes their time documented to 30 mins. Is that legal/ethical?
I feel like the provider is doing it to boost revenue.
Any advice would be greatly appreciated.
 
dschlaefli said:
Hello,
I am in a questionable situation and would like to understand others opinions.
If a provider documents they spent 10 mins with the patient, but want to bill out a 99497 which requires 30 mins documented time. If the provider goes back and changes their time documented to 30 mins. Is that legal/ethical?
I feel like the provider is doing it to boost revenue.
Any advice would be greatly appreciated.
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99497 requires a minimum of 16 minutes to bill. 99497 is for the first 30 minutes of ACP. One unit of 99497 represents 16-45 minutes of ACP time. 15 minutes or less of ACP is not billable at all.

See page 4 of this CMS MLN for a time chart explaining that: https://www.cms.gov/outreach-and-ed...mlnproducts/downloads/advancecareplanning.pdf

Regarding your provider changing the time from 10 minutes to 30 minutes, I would question that.

How is the provider allegedly remembering "Oh no, I really spent X minutes with that patient" days the fact? Can anything substantiate how much time they spent with the patient? For example, does the practice's EMR have time stamps indicating how much time the provider spent during the visit?

You asked if it was legal/ethical for a provider to misrepresent time to capture additional revenue. No, that would not be legal or ethical.

Theoretically, a provider can amend documentation if there is an error. However, the documentation should accurately reflect the visit. It sounds like your gut feeling is that the provider misrepresented the time, so they could get reimbursed.

I think it would be wise to keep an eye out to see if this is a pattern of behavior.
 
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