In the Edge Blast #123 - Question # 3 I beg to differ:
Answer should be 99213, 99401 as opposed to 99212, 99401.
Assumption
15 minutes of time spent counseling the patient constitutes more than 50% of the E&M and time becomes the key factor. That is, 15 minutes out of 25 minutes (99212 - 10 minutes) is spent counseling. 99401 - 99405 are non-reimbursable services for Medicare. Physician documentation support Total time : 25 minutes; Time Spent counseling 15 minutes; and Topic of Counseling: Preventive Medicine for patient at high risk of Breast Cancer.
Theory
Based on the AMA CPT 2009 Edition, the E&M should not have been based on problem focused history and exam, but on time as the key factor of the E&M of 15 minutes. Time of 15 minutes is a 99213. Should we count 25 minutes as Times? Also, since Medicare doesn't pay for a 99401, it is only provided to acknowledge the amount of time spent in the session counseling.
Debate
Please explain why this may be incorrect or what is the purpose of the counseling code (99401) if it doesn't enhance the E&M code (i.e., reimbursement)?
Thanks,
Eddie Hearns MA, CPC-I
Answer should be 99213, 99401 as opposed to 99212, 99401.
Assumption
15 minutes of time spent counseling the patient constitutes more than 50% of the E&M and time becomes the key factor. That is, 15 minutes out of 25 minutes (99212 - 10 minutes) is spent counseling. 99401 - 99405 are non-reimbursable services for Medicare. Physician documentation support Total time : 25 minutes; Time Spent counseling 15 minutes; and Topic of Counseling: Preventive Medicine for patient at high risk of Breast Cancer.
Theory
Based on the AMA CPT 2009 Edition, the E&M should not have been based on problem focused history and exam, but on time as the key factor of the E&M of 15 minutes. Time of 15 minutes is a 99213. Should we count 25 minutes as Times? Also, since Medicare doesn't pay for a 99401, it is only provided to acknowledge the amount of time spent in the session counseling.
Debate
Please explain why this may be incorrect or what is the purpose of the counseling code (99401) if it doesn't enhance the E&M code (i.e., reimbursement)?
Thanks,
Eddie Hearns MA, CPC-I
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