Time Based E/M

Deb2009

Networker
Messages
74
Best answers
0
When billing for time based E/M, does the documentation first need to meet a 99213 - 99215, and then look at the time or can you go directly to the time that the provider has documented? for example: "Today’s visit was 60 minutes with more than 50% of the total time spent with the patient in counseling and coordination of care." Thank you in advance for your responses.
 

twtcpc

Guru
Messages
191
Best answers
0
When billing for time based E/M, does the documentation first need to meet a 99213 - 99215, and then look at the time or can you go directly to the time that the provider has documented? for example: "Today’s visit was 60 minutes with more than 50% of the total time spent with the patient in counseling and coordination of care." Thank you in advance for your responses.

Hi,

I've seen both ways done; however when I was taught auditing, my instructor told us to always check the note for the "elements" (history, exam, MDM) level and the time and use which is most advantageous to the provider. Most I have come across have met higher on the time; however I have had a few rare cases where the elements came to higher level and surprisingly without template use but dictated notes.

T
 

Deb2009

Networker
Messages
74
Best answers
0
Thank you, that is what I what I have done also. We are having discussion that the "elements" must be there 1st and then if time brings it higher then you go with time. I always just 'glance' at "elements" if time is documented! Not sure if that is correct or not? So you are saying that "elements" must be there and then if time takes it to a higher level then you go with time?
 

twtcpc

Guru
Messages
191
Best answers
0
Thank you, that is what I what I have done also. We are having discussion that the "elements" must be there 1st and then if time brings it higher then you go with time. I always just 'glance' at "elements" if time is documented! Not sure if that is correct or not? So you are saying that "elements" must be there and then if time takes it to a higher level then you go with time?
Not necessarily the elements, but the medical necessity must be. For instance, I work with pediatric specialty groups some of which are more "hands off" than "hands on" meaning their visits are more review of data ordering tests, and not necessarily having information to support HPI on subsequent visits or need to do an exam - such as genetics, hem/onc does a lot of counseling and coordination of care. I've even had cases in urology where the pregnant mother was referred to our pediatric urologist because prenatal ultrasounds showed an issue with the renal system of the fetus and the MD will meet with the mother prior to birth to review films, provide reassurance and/or start a plan of care to address at time of birth so technically the patient was the fetus, but you can't perform an exam on a baby still in the womb :unsure: so the visit was more counseling and coordination of care and billed based off of the time spent with the mother.
 

twtcpc

Guru
Messages
191
Best answers
0
I forgot to add, don't forget to watch for template of the same time statement repeatedly...especially in regards to the total time and the content of the counseling. I've had to work on that with some of mine.
 
Top