Time based coding - taught in coding

Ann

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I am looking for some information regarding rounding time based office visits. I have been informed that you can round time based office visits to the next higher level. This is not what I have been taught in coding school. Any help would be appreciated.
 

magnusrune

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OV time

As far as I know, there is no "rounding up". That can be easily interpreted as fraud (if not by definition). Document time spent with patient and bill accordingly (E/M plus prolonged visit if needed) but you just dont round it off and bill as such. Time is the last factor anyway in regards to E/M. Until the ROS, Physical exam, and MDM requirements are met, time is not a factor. Bottom line is that you cannot bill for time/services not actually spent with the patient so you may want to talk with whoever gave you that advice.
 

ollielooya

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Actually I have heard of it, and certain parameters were needed to be satisfied before that would happen but can't elaborate as to the outcome.
And your CPT book does give a pretty good definition of EM time based coding in the very last EM section paragraph. Find it and re-read. When counseling and/or coordination of care DOMINATES (more than 50%) ....then TIME shall be considered the KEY or CONTROLLING factor to QUALIFY for a particular Level of EM services (CAPS have been added) If the documentation satisfies the criteria and the provider has stated that over 50% of time has been spent with the patient in counseling/coordination of care the other elements for for the standard EM Visit do not come into play. Time IS the controlling factor. This is my understanding. And I'm open to debate or rebuttal as a learning experience.

---Suzanne E. Byrum CPC
 

espressoguy

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Actually I have heard of it, and certain parameters were needed to be satisfied before that would happen but can't elaborate as to the outcome.
And your CPT book does give a pretty good definition of EM time based coding in the very last EM section paragraph. Find it and re-read. When counseling and/or coordination of care DOMINATES (more than 50%) ....then TIME shall be considered the KEY or CONTROLLING factor to QUALIFY for a particular Level of EM services (CAPS have been added) If the documentation satisfies the criteria and the provider has stated that over 50% of time has been spent with the patient in counseling/coordination of care the other elements for for the standard EM Visit do not come into play. Time IS the controlling factor. This is my understanding. And I'm open to debate or rebuttal as a learning experience.

---Suzanne E. Byrum CPC
That's my understanding as well, Suzanne.

I have an ARNP who does inpatient wound care and one day she documents that she spent 60 minutes providing care. From her note it was clear that more than 50% of her time was spent coordinating and counseling. Unfortunately, she didn't use the magic words "over 50%" so I couldn't upgrade her from a 99231 to a 99233.

Yesterday I got a charge sheet from her where she selected 99223 and documents 60 minutes with over 50% of her time coordinating and counseling. Now I have to tell her that initial inpatient visit time for 99223 is 70 minutes. So close. :p
 
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