Wiki Time-based coding

Create Wiki
L

Lbibian

Contributor
Messages
12
Location
Granada Hills, CA
Best answers
0
Hi. I'm a rookie coder, and I received this question from one of our providers about coding based on time, which could potentially lead to a higher level, such as a 99215. What would be the "by the book" answer for this provider? Your advice will be very much appreciated

We have been told that time is a very valid consideration in calculating complexity. How should we be relatively objective about the value of the time spent.

I (and many others) would absolutely argue that a very scared patient requires more time than one who is nonchalant and deserves to have more time taken with them. This is important to their health and to decrease their use of the health care system. Why should I not charge for that, even when the illness is not complex?
 
"I spent xxx minutes with this patient in evaluation, examination and discussion of treatment and options of the (xxx) problem/condition including face to face time, and with chart review and documentation" or "Total time spent on patient care today was xx minutes, including: review of clinical lab tests, review of medical tests/procedures/services, counseling and educating the patient on medication management, documentation of the encounter, and ordering follow-up lab tests."

Also, if a procedure is done at the same time, you would want to add, "this excludes time spent in separately reportable services".
 
Lbibian said:
Hi. I'm a rookie coder, and I received this question from one of our providers about coding based on time, which could potentially lead to a higher level, such as a 99215. What would be the "by the book" answer for this provider? Your advice will be very much appreciated

We have been told that time is a very valid consideration in calculating complexity. How should we be relatively objective about the value of the time spent.

I (and many others) would absolutely argue that a very scared patient requires more time than one who is nonchalant and deserves to have more time taken with them. This is important to their health and to decrease their use of the health care system. Why should I not charge for that, even when the illness is not complex?
Click to expand...
Hi there. It sounds like you might be mixing requirements for medical decision-making, were complexity of the problem addressed can be a factor in coding a visit, and the requirements for time-based coding for E/M visits.

The good news is that for time you just need the provider to document what they did on the date of the face-to-face encounter along with the time. (See your CPT Manual). Remind providers that they can count relevant work before and after the face-to-face encounter so they don't lose credit.
 
Pam Warren said:
"I spent xxx minutes with this patient in evaluation, examination and discussion of treatment and options of the (xxx) problem/condition including face to face time, and with chart review and documentation" or "Total time spent on patient care today was xx minutes, including: review of clinical lab tests, review of medical tests/procedures/services, counseling and educating the patient on medication management, documentation of the encounter, and ordering follow-up lab tests."

Also, if a procedure is done at the same time, you would want to add, "this excludes time spent in separately reportable services".
Click to expand...
Great advice! Thanks
 
jkyles said:
Hi there. It sounds like you might be mixing requirements for medical decision-making, were complexity of the problem addressed can be a factor in coding a visit, and the requirements for time-based coding for E/M visits.

The good news is that for time you just need the provider to document what they did on the date of the face-to-face encounter along with the time. (See your CPT Manual). Remind providers that they can count relevant work before and after the face-to-face encounter so they don't lose credit.
Click to expand...
You're right, and this makes perfect sense. Thank you
 

For office/outpatient E/M: Don't be vague. Don't use time ranges or greater than XX minutes. Be specific. Don't use the old "Greater than half (or 50%) spent on counseling and coordination of care" statement. Don't document time in every single note with the same cloned statement. Only document the time if you intend to bill the E/M using time. Don't document a time which would actually decrease the E/M level if the visit had been coded based on MDM instead. Be specific, explain what was done and what the time was made up of, give an exact time in minutes, use "I" statements. If the visit is very basic & straightforward and would be a 2 or 3 by MDM yet you are billing a level 5 because it took so long, WHY did it take so long? Explain.
 
I wish the E/M section specifically excluded non-medical discussion from time for the level-based codes. If a patient or provider (or both) are very chatty you might wind up with 40 minutes of time, but 10 minutes of conversation about family, the weather etc, is sprinkled in there and that shouldn't be counted.

Of course, I really wish there was clear, detailed, official guidance for documenting time. I think CMS is "keeping its options open" for a few years while auditors review notes and everyone else is waiting for them. I know the AMA has said it doesn't need to be time per activity, but I don't think that guidance has even made it to a CPT Assistant.
 
You must log in or register to reply here.
Top