Wiki Coding time based E/M service when time spent is less

[sherivickery]

I've been asked by a hospitalist who sees residents in a nursing facility the best way to code his services when the 30-minute description of 99309 is more than he needs or uses. The service, advanced care planning, is accurate for his work, he just wants clarification about the time requirement.

 

[jkyles]

Hi there, I assume you're asking about the time requirement for subsequent NF code 99309 that will go into effect next year. If so, the hospitalist must meet the minimum time requirement for the code. The descriptor is:

Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history
and/or examination and moderate level of medical decision making.

When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.

CPT "half-time" rules don't apply.

However, make sure the hospitalist understands they can count time for the 9 related activities that are performed on the same day as the face-to-face visit. I've seen instances where the provider only captures the time for the face-to-face portion and that may not reflect all the work they did on that day.