Wiki E/M time based

[alibella81]

Good morning,

I'm coding professional fees for gyn-oncology and I'm coming across a lot of high level E/M such as 99205, 99215 and the provider is doing it by time. Not all of these are for oncology diagnoses. My question is do I solely depend on the time documented or what does the supporting documentation need? A lot of these patients are counseled for surgery too. Of course now that the office knows about the prolonged time code I'm receiving a lot of charges with that attached as well. I guess my concern is if we are solely going on time but the patient is treated for one problem that is moderate the documentation will not support it.

Thank you so much!

 

[jkyles]

Good morning,

I'm coding professional fees for gyn-oncology and I'm coming across a lot of high level E/M such as 99205, 99215 and the provider is doing it by time. Not all of these are for oncology diagnoses. My question is do I solely depend on the time documented or what does the supporting documentation need? A lot of these patients are counseled for surgery too. Of course now that the office knows about the prolonged time code I'm receiving a lot of charges with that attached as well. I guess my concern is if we are solely going on time but the patient is treated for one problem that is moderate the documentation will not support it.

Thank you so much!

Hi there, documentation for time-based coding is one of those grey areas. The CPT guidelines do not include information on what to document, so you'll need to check the specific payer or MAC to see if it has issued any guidance.

However, if they are coding based on time, how the visit might be coded under MDM is not relevant.

I think the greater concern with time-based coding is when you get into "impossible" amounts of time. An extreme example would be if the total time for all E/M claims submitted by a doctor for a day exceeded 24 hours.

 

[SharonCollachi]

Some of your commercial plans have restrictions on the extended time codes (limited dx). Just an FYI.

 

[jkyles]

Some of your commercial plans have restrictions on the extended time codes (limited dx). Just an FYI.

Good point, I forgot that CMS has a medically unlikely edit of 4 (with appeal allowed) for G2212.

 

[SharonCollachi]

Good point, I forgot that CMS has a medically unlikely edit of 4 (with appeal allowed) for G2212.

Blue Cross of California has a list of accepted dx for G2212 on their webpage.

 

[alibella81]

Thank you so much! That is very helpful about accepted dx