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Our provider states that she spent 25 minutes total time face to face with patient with 50% involved with patient counseling and care. She billed a new patient visit of 99203 based on time. This is a new patient, can she bill 99203 even though her dictation says 25 minutes? Can I round up or down?

Thanks!

Denise
 
To bill based on time

To bill based on time spent in counseling/coordination of care you must have:
1) total amount of time spend face-to-face with patient
2) Amount of time spent in counseling/coordination of care (must be greater than 50% of total time)
3) nature of the counseling/coordination of care

As an example: I spent 25 minutes face-to-face with the patient today, 15 minutes of which was spent in counseling regarding weight management and risks for diabetes especially given her family history.

So if total of 25 minutes is spent face-to-face with the new patient, the highest level you could code would be 99202.

HOWEVER, I would not use time spent counseling to determine the level of service in your scenario because that counseling is not greater than 50%. I would code the visit based on the key elements: history, exam, MDM.

F Tessa Bartels, CPC, CEMC
 
You should never round up when using time!
If the provider spends (for example) 5 minutes more than the time indicated with the patient that would be ok, but if 5 minutes less than the level requires are spent with the patient, that will be frowned upon.
Also keep in mind that coding based on time is not always appropriate. Time must be the driving factor. If your provider just makes the time statement but the counseling is not dominating (GREATER THAN 50%) the visit, then you should base the code on the elements.
 
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