E&M based on time w/no exam?

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Can a physician bill a 99205 or any e&m based on time only? There wasn't an exam done. The patient was seen basically to discuss her options.... Help please! Thanks
 

rthames052006

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Can a physician bill a 99205 or any e&m based on time only? There wasn't an exam done. The patient was seen basically to discuss her options.... Help please! Thanks
You do have the option to bill based on time for e/m codes. Total time of the visit must be documented, along with time spent in counseling/coordination of care ( which must be atleast 1/2 of the time) and some documentation of what was discusssed. If you look in your cpt book, you'll see the time estimates listed in each code description.
 
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I know you can have E&M's where time trumps everything else. And I have read the "time" guidelines in the CPT however I wasn't sure if all the rules are the same when the entire visit is only time spent and nothing else was done. No HPI, no ROS, no exam and no MDM just time spent counseling the patient on options.

Thanks,
Ashley
 

hbeard

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what about using 99499 for unlisted e/m service...this might depend on the payer rules but maybe it could be a choice to consider
 

rthames052006

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I know you can have E&M's where time trumps everything else. And I have read the "time" guidelines in the CPT however I wasn't sure if all the rules are the same when the entire visit is only time spent and nothing else was done. No HPI, no ROS, no exam and no MDM just time spent counseling the patient on options.

Thanks,
Ashley
I'd have to say... that their must has to be atleast a brief HPI or CC based on the provider conseling the patient on options? Options for what? What is the provider counseling the patient on? That could be your brief HPI or CC. You would atleast have something, ya know.

Here is what CMS has to say about it at https://www.cms.gov/manuals/downloads/clm104c12.pdf



C. Selection Of Level Of Evaluation and Management Service Based On Duration Of Coordination Of Care and/or Counseling
Advise physicians that when counseling and/or coordination of care dominates (more than 50 percent) the face-to-face physician/patient encounter or the floor time (in the case of inpatient services), time is the key or controlling factor in selecting the level of service. In general, to bill an E/M code, the physician must complete at least 2 out of 3 criteria applicable to the type/level of service provided. However, the physician may document time spent with the patient in conjunction with the medical decision-making involved and a description of the coordination of care or counseling provided. Documentation must be in sufficient detail to support the claim.
EXAMPLE: A cancer patient has had all preliminary studies completed and a medical decision to implement chemotherapy. At an office visit the physician discusses the treatment options and subsequent lifestyle effects of treatment the patient may encounter
or is experiencing. The physician need not complete a history and physical examination in order to select the level of service. The time spent in counseling/coordination of care and medical decision-making will determine the level of service billed.
The code selection is based on the total time of the face-to-face encounter or floor time, not just the counseling time. The medical record must be documented in sufficient detail to justify the selection of the specific code if time is the basis for selection of the code.
In the office and other outpatient setting, counseling and/or coordination of care must be provided in the presence of the patient if the time spent providing those services is used to determine the level of service reported. Face-to-face time refers to the time with the physician only. Counseling by other staff is not considered to be part of the face-to-face physician/patient encounter time. Therefore, the time spent by the other staff is not considered in selecting the appropriate level of service. The code used depends upon the physician service provided.
In an inpatient setting, the counseling and/or coordination of care must be provided at the bedside or on the patient‟s hospital floor or unit that is associated with an individual patient. Time spent counseling the patient or coordinating the patient‟s care after the patient has left the office or the physician has left the patient‟s floor or begun to care for another patient on the floor is not considered when selecting the level of service to be reported.
The duration of counseling or coordination of care that is provided face-to-face or on the floor may be estimated but that estimate, along with the total duration of the visit, must be recorded when time is used for the selection of the level of a service that involves predominantly coordination of care or counseling. "
 
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CBaer

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New ptn based on time

Depending on what the counseling is...it could be 99401- 99429. Keeping in mind not all carriers reimburse for these codes.

Have a great day

Cheryl
 
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