Wiki Debate on coding by time..please help

[1073358]

I am running in circles in my head trying to decipher this. Let's say we have a new patient office, you can not count unit floor time, if a doc states out of 60 min, 45 min was spent face to face.. what was the other 15 spent doing? If they cant count chart review, etc in their time, what is it they were doing? I am not grasping something fairly simple here.
2) With that same visit, if 60 min total and 45 face to face, what is appropriate code? the 99205 for the 60 total min or would you choose 99204 for the 45 min? I am so confused on this now.

Help me make it make sense again!!

 

[Lisa Bledsoe]

What the doctor needs to be stating is that out of 60 minutes, 45 minutes were spent in counseling, with his/her summarization of what was discussed during counseling. Then you have a time based code. Just stating face-to-face doesn't do much for documentation. With your example, if the doctor is only stating "face-to-face" I think I would look at the documentation content (History/Exam/MDM) to determine the level of service. Hope that helps...

 

[FTessaBartels]

Audit proof documentation

Audit-proof documentation for time-based coding would be something along lines of:
I spent 60 minutes face-to-face with patient; 45 minutes of that time was spent in counselling/coordination of care, discussing treatment options, benefits and risks.

To choose an E&M level based on time spent three elements must be met:
1. Total time spent in face-to-face encounter
2. Amount of time spent in counseling/coordination of care (can be listed as percentage but must be MORE than 50%)
3. Nature of the counseling/coordination

You choose the level of service based on the total time spent.

F Tessa Bartels, CPC-E/M