coding time spent

samyjm13

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Meridian, ID
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I have 2 scenerios: 1. I have an orthopedic who codes 99214, 99215, 99204-05 and there documentatio is not there for those high codes, so now he is using "time spent with patient" on everyone of his pt's docs. to get the higher level, the things is documentation does support it. Even so I know that what it is. Any suggestions.

2. Then I have a doc. that will document the time but the documentation isn't there to support the time and I have quaried and educated him but he still won't give the documentation for the high number of minutes spent (ie 60 minutes on most of them)

any suggestions.
Thanks
 

rthames052006

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Local Chapter Officer
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The first thing I would do is pull out ( and show) these providers your reference materials showing how to document time correctly in order to qualify for the level of service they are billing for.

If their documentation is not supporting the level they are choosing, you have no choice but to down-code the services based on guidelines.

Good luck :)
 

mmorningstarcpc

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Also, lets be realistic. If doctor is saying he spent 60 minutes with each patient, does he only see eight patients a day? If he is seeing 20-25 patients a day, he is not spending an hour with each of them! Same for the other doctor that is documenting time. I bet if you added up his "times" for an entire day, his time would be way more than eight hours also.
 

penguins11

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I actually know of a situation where an unhappy employee reported a previous employer for incorrectly reporting based on time. The documentation was there stating he spent the time but it was obvious based on the schedue that he could not have because he would have been there along with staff untill 10pm or later. The carrier actually requested copies of schedules and check in and check out records from their computer system, they had to pay back a whole lot of money. Also, the dr cant just dicate total time spent, he has to dictate that more than 50% of the office visit was spent on counseling and coordination of care.
 
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