Wiki Coding based on Time

[Moatman]

Requesting clarification. When auditing and providers are coding based on Time. The Medicare scorecards indicate Average time. Does that mean that if the provider documents that 50% of the time was spent in counseling and time spent is 20 minutes does qualify as a 99214? would appreciate any advice or direction where I can get written documentation to support appropriate coding.
Thank you,
Maria CPC

 

[MJ4ever]

Hi There,

Refer to the last paragraph of the 1995 medicare guideline.

https://www.cms.gov/MLNProducts/Downloads/1995dg.pdf

D. DOCUMENTATION OF AN ENCOUNTER DOMINATED BY COUNSELING OR
COORDINATION OF CARE
In the case where counseling and/or coordination of care dominates (more than 50%) of the
physician/patient and/or family encounter (face-to-face time in the office or other outpatient setting or
floor/unit time in the hospital or nursing facility), time is considered the key or controlling factor to
qualify for a particular level of E/M services.
!DG: If the physician elects to report the level of service based on counseling
and/or coordination of care, the total length of time of the encounter (face-to-face or
floor time, as appropriate) should be documented and the record should describe
the counseling and/or activities to coordinate care.

If it is supported according to this you may bill for the alloted time for the given face-to-face time given for each E&M code.

Hope this helps,

Barbara