Counseling--Banging My Head Against Wall!

goldkapp

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I have a provider who thinks every visit is based on counseling. She counsels them on "everything," or so she says. I've tried to talk to her about this and convince her that in her family practice area, very few visits should be coded based on time. Are there any good resources that I could access to drive the point home?

Thanks.
 

sbicknell

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I am not aware of any guideline out there that is specifically going to say "talking to your patient does not equal coding based on time"

Explain to her that she is expected to talk to her patient. Starting the pt on a new RX it is expected that she explain the why, purpose etc of the new RX. Telling the patient with hyperlipidemia to quit eating the 3 greasy cheeseburgers a day is expected. Answering the Mom's questions about her kid's OM is expected

Point out to her the payers will pend her claims and request the note when they receive a high level code for a simple DX. It will be a big red flag on her and on the practice to see an encounter for a wart or rash coded based on time (yes, possible but not probable)

Coding the encounter based on time is for above and beyond the normal expected Physician-Patient interaction. It's for the newly diagnosed DM patient, the patient wanting to discuss birth control options, the patient/spouse scheduled for a surgery and the expected post op recovery/care.

Documentation must include
1) total face to face time
2) time spent counseling/coordinating
3) sufficeint detail to support time claimed
 

kimscoding

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I agree with SBicknell.

You could also look up CPT assistance and see if there is anything in there for you to direct the doctor.

Good Luck and I hope all turns out well.
 
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Also ...

Most experienced physicians can take an appropriate history, examine and develop a treatment plan - even for a 99215 - in FAR less time than the "averages" listed in CPT.

A 99214 requires at least 21 minutes of face-to-face time (with at least 11 minutes spent in counseling) if it is to be billed based on time. An experienced physician can probably perform this service in 10-15 minutes.

And finally ... if she is coding ALL visits based on time ... those times for all patients seen in one day better not add up to more time that she was actually in the office. Trust me, someone is going to check.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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pnwcoder

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We have a family practice Dr in our group that does this also, even prolonged services visits of up to 2 hours! We've brought it up to provider and looked online and found nothing that says this can't be done only that it can raise a red flag. Not sure what good a red flag is if there's nothing that says you can't use time for every visit. We were told the only real thing that could cause a problem is if total time documented for that day adds up to more hours than the provider worked that day. I don't think time should be done routinely except maybe with some specialties but what are you going to do? Some providers seem to see it as an easy way to document and get the level they want.
 

Hylandd

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billing 99401 with prev & EM codes

We have a ob/gyn doc who has started billing for a well-woman exam plus 99401. So far no ins has paid for the 99401. Know medicare does not allow 99401. Is there any reason to bill a 99401 with another proc code if the insurances are not going to cover?
 
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