Time Based Coding-1/2 spent counseling

SUEV

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Local Chapter Officer
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Per CPT, when more than half of the visit is spent on counseling/coordination of care, you can bill based on time when documented correctly. I have a provider who documented the total time as 60 minutes with 30 minutes of the appointment spent on counseling, etc.
From my understanding, this visit wouldn't qualify for time-based or am I being too strict? Thanks for your opinions,
Sue
 

MikeEnos

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Providence, RI
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Going by the strict interpretation of the 1995 guidelines, it is supposed to be greater than 50% of the visit. So technically 30 is not greater than 50% of 60. I'd cut him some slack but have him phrase it differently. Something like, "This was a 45 minute visit, greater than 50% was spent counseling the patient regarding stretching exercises and daily walks."

. DOCUMENTATION OF AN ENCOUNTER DOMINATED BY COUNSELING OR COORDINATION OF CARE
In the case where counseling and/or coordination of care dominates (more than 50%) of the
physician/patient and/or family encounter (face-to-face time in the office or other outpatient setting or
floor/unit time in the hospital or nursing facility), time is considered the key or controlling factor to
qualify for a particular level of E/M services.

DG: If the physician elects to report the level of service based on counseling
and/or coordination of care, the total length of time of the encounter (face-to-face or
floor time, as appropriate) should be documented and the record should describe
the counseling and/or activities to coordinate care.
 
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