ejthornton
Contributor
We have a provider that does time based coding, but they are only spending 7 or 9 mins with the patient, can I bill a 99212?
-
If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
Wiki Time Based E/M
- Thread starter ejthornton
- Start date
CBLENNIE
Expert
For time based E&M coding you count the face to face and non-face to face time spent on the patient per the following coding guidelines from the AMA. Here are the 2023 E&M guidelines:
Additionally, the guidelines provide information regarding what services can be counted as part of the time spent on the encounter and services that cannot be applied to the time calculation on the date of the encounter:
So, if the provider is spending 7-9 minutes face-to-face with the patient and there is eligible non-face to face time spent on the patient on the date of the encounter and you can meet or exceed the 10-minute minimum for billing 99212 then you should be able to bill 99212. The non-face to face time would need to be documented in the patient's records as part of the visit on the date of the visit.
I'm not an expert at E&M documentation but maybe someone else can help you determine what needs to be documented in the record for the non-face-to-face time so that you can support billing 99212 based on the total time spent on the encounter (both face-to-face and non-face-to-face).
Additionally, the guidelines provide information regarding what services can be counted as part of the time spent on the encounter and services that cannot be applied to the time calculation on the date of the encounter:
So, if the provider is spending 7-9 minutes face-to-face with the patient and there is eligible non-face to face time spent on the patient on the date of the encounter and you can meet or exceed the 10-minute minimum for billing 99212 then you should be able to bill 99212. The non-face to face time would need to be documented in the patient's records as part of the visit on the date of the visit.
I'm not an expert at E&M documentation but maybe someone else can help you determine what needs to be documented in the record for the non-face-to-face time so that you can support billing 99212 based on the total time spent on the encounter (both face-to-face and non-face-to-face).
jkyles
True Blue
- Messages
- 937
- Best answers
- 1
Hi there, you cannot. As noted above you should remind the provider that they can count non-face-to-face time on the date of the encounter. If a QHP also contributes to the encounter, you can combine their time.
I believe the best practice is to document the work as though the visit will be coded based on MDM and also include the total time.
Having said that, your provider might decide that keeping track of the time they spend on each patient's care throughout the day of the visit is too much trouble and prefer to just code based on MDM.
Also remember that they can't use average time. For example, if they spend 30 minutes reviewing test results for three patients they can't divide that up and say they spent 10 minutes per patient.
Last edited:
I have provider that documented 15 min time spent but the documentation in note shows a level 4 . Could I bill the level even though the note says time spent: 15 minutes?
CBLENNIE
Expert
Can you clarify what you mean when you stated, "the documentation in the note shows a level 4.", is this information entered by the provider's documentation of the visit? The minimum time required for a level 4 visit is 30 minutes. Is there any chance that the visit was documented as a level 4 based on MDM and not time? If so, when you review the record does the claim meet the MDM criteria for a level 4 visit?
If the claim wasn't leveled based on MDM and time is being used, then no, a 15-minute visit doesn't meet the minimum time requirement for a level 4 visit which is at least 30 minutes. If the E&M is being leveled on time alone based on the time documented being 15-minutes, this would be a 2 which is a minimum of 10 minutes and unfortunately the minimum time for a level 3 visit is a minimum of 20 minutes.
If the claim wasn't leveled based on MDM and time is being used, then no, a 15-minute visit doesn't meet the minimum time requirement for a level 4 visit which is at least 30 minutes. If the E&M is being leveled on time alone based on the time documented being 15-minutes, this would be a 2 which is a minimum of 10 minutes and unfortunately the minimum time for a level 3 visit is a minimum of 20 minutes.
Cheezum51
True Blue
This is why I discourage clients I work with from coding based upon time. In many cases, the visits would be under coded if chosen based upon time.
Tom Cheezum, OD, CPC, COPC
amyjph
True Blue
When you say, "does time based coding", do you mean they document the time in every visit note and expect that the visit will be coded by time for each one? Is the EMR just a template that is automatically filling that field out but the provider doesn't actually "choose" it? How do you know they are spending 7-9 minutes, does it say that in the documentation? What does the full documentation actually say?
There is a bit more to this question and it is tough to answer without seeing an actual note. What is the specialty?
As advised above, if it is specifically stating 7-9 minutes and that is all, you can't bill a 99212. In that case, it would be better not to document time at all and code based on MDM. However, from an auditing perspective, if the time is specifically documented in the note, most auditors are going to think the provider intended to code by time and look at it that way. It's better to leave the time statement out all together if a provider does not want it coded that way.