E/M in inpatient settings


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How do you interpret the following from the Medicare Claims Processing Manual Chapter 12 section 30.6:

"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
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
applicable to the type/level of service provided. However, the physician may
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". The preceding paragraph is also in the CPT book.

"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
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
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
predominantly coordination of care or counseling".

I hope I copied enough for you to help me out. The question comes down to can coordination of care on the floor mean only chart time? Any thoughts are appreciated.


Louisville, KY
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No, not entirely. As it is spelled out, there must be coordination of care (that's not charting), medical decision making (still, not solely charting) and evidence they are appropriate for the patient condition (not really mentioned, but reflected in the MDM, COC and ICD).

Charting is an administrative function and although allowances are made for that on the IP side, the antecedent of all the commentary you mentioned was Couseling and/or COC.

Hope this helps.