Initial visit based on time only ???

[Orthocoderpgu]

Is there someone with an E/M specialty credential that can give me an answer to this? Doc does an initial visit and does not perform an exam. Because the New Patient codes REQUIRES meeting the three key components, new patient visits cannot be based on time only. Right?

 

[Brenda Koldys]

CPT guidelines state, that in the case of visits that consist promininantly of couseling or coordination of care, time may be considered a factor to qualify for a particular level of EM service.

Time must be documented properly. The time spent couseling should be reasonable for the presenting problem.

Brenda Garrison, CPC, CPC-I

 

[FTessaBartels]

Counseling & Coordination of Care

When a visit is being coded based on counselling & coordination of care, the key elements of History, Exam and MDM do not need to be met.

In order to code "based on time" the documentation MUST include all of the following:
1) the total time spent face-to-face with the patient
2) the amount of time spent in counseling / coordination of care (must be more than 50% of total time)
3) the nature of the counseling/coordination of care

For example:
I spent 20 minutes in direct care with Mr New Patient today discussing his hopes for weight loss management. 100% of this visit was spent in counseling/coordination of care, outlining our weight-loss program and risk of continued obesity.

This note would qualify for a 99202.

Hope that helps.
F Tessa Bartels, CPC, CEMC

 

[LLovett]

Just a thought, there are new patient codes that can not be based on time, the preventive codes 99381-99387. While there are no specific guidelines on how much exam is required it is still required.

I don't think that is your scenario though. I have several providers that use time a lot in their new patient visits. Generally they do some exam but the time is the determining factor for the level. It is appropriate to use either key components or time in new, established, and consult codes for E/M.

Laura, CPC, CEMC