E/M CMS 1997 DG Using Time as Basis of Visit

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I am seeking input from other coders about a documentation requirement I thoguht I had seen somewhere, but can't find, concerning the necessity to document who was present during a visit, when time is the basis for the visit...is this required, to state something such as "patient here alone", or "patient here with partner" in order for time where counseling/coord care dominates the visit? Does anyone know of a document source that states this as a requirement? I have reviewed the 1997 CMS DG and do not see it, and also searched Trailblazers a bit...Any help you can provide would be appreciated!
 

viola25

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I have not heard of such requirement. I know that in order to bill based on time the provider has to document the time spent with patient and that over 50% of that time was spent on counseling and what was the patient counseled on.
 

ollielooya

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I have not heard of this per 95 or 97 guidelines. However once again, consult your CPT book, last paragraph in the EM guidelines before the actual listing of codes. Part of the time based coding states ".........This includes time spent with parties who have assumed responsibility for the care of the patient or decision making whether or not they are family members (eg. foster parents, person acting in loco parentitis, legal guardian......" So by the criteria stated in application of time-based coding, perhaps this is the answer you're looking for? The statements you provided with your question surely wouldn't hurt the documentation. ---Suzanne E. Byrum CPC
 

LLovett

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Medicare requires the patient be present for the service to be billable. There are of course some exceptions on the inpatient side to this requirement. It is not in the documentation guidelines. It is published in their manuals. See below for link and excerpt.

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads//clm104c12.pdf

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.

Laura, CPC, CPMA, CEMC
 

ollielooya

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Thanks Laura for the reminder about the MCR requirements requiring the patient to be present to be billable. ---Suzanne
 
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