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Would this be a 99212 or 99213?

I did spend 12 minutes today with the patient going over the above, and greater than 50% of this time and nearly the
entirety thereof was in direct patient counseling and coordination of care.
 

rsinoben

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99212

99213 would have required 15 minutes with greater than 50% spent on counseling and coordination of care.
 

twizzle

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Would this be a 99212 or 99213?

I did spend 12 minutes today with the patient going over the above, and greater than 50% of this time and nearly the
entirety thereof was in direct patient counseling and coordination of care.
This would be a 99212 because the time has not reached 15 minutes which is the threshold for 99213. So even if your provider spent 14 minutes it would still be 99212, not 99213.

All this assumes your provider included documentation of the nature of counseling in the encounter. A blanket statement of time and >50% spent counseling is insufficient and you would have to code from the three key E/M elements instead. The exception would be if the whole encounter was counseling which does happen.
 
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twizzle

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Coding on time

This would be a 99212 because the time has not reached 15 minutes which is the threshold for 99213. So even if your provider spent 14 minutes it would still be 99212, not 99213.

All this assumes your provider included documentation of the nature of counseling in the encounter. A blanket statement of time and >50% spent counseling is insufficient and you would have to code from the three key E/M elements instead. The exception would be if the whole encounter was counseling which does happen.
I should have added that your provider needs to improve his time statement by documenting that they spent 12 minutes 'face-to-face' with the patient.
 
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Thanks for the replies. Sometimes the physician will document 21 minutes face to face with patient, 100% counseling. This would be ok to bill at 99214 for an established patient, right?
 

mitchellde

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A level 4 needs to be 25 minutes if it is to be coded by time. I get these a lot also and with very little documented in terms of the 3 key criteria I give them a 99213 assuming established.
 

Pathos

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Look in the CPT book for time thresholds and you will find the exact duration for each type of visit.

My local MAC (Noridian) also explains time documentation further:

"Time Based Services
While some CPT codes allow the LOS to be time based, it is not acceptable to simply state "35 minutes spent with patient discussing treatment." When counseling and/or coordination of care is the key factor is determining LOS, documentation needs to support the amount of time spent in discussion and detail the context of the conversation and any decisions made or actions that will result based on this counseling. Per CPT, time can be used as the controlling factor for LOS when the counseling and/or coordination consume at least 50% of the total office visit. Refer to the article titled "Evaluation and Management: Time" located in CPT Assistant Volume 10, Issue 12, December 2000. This article has extensive information regarding the elements required when billing based on time.
"

CMS E/M guidelines also addresses this subject.

You would not want a provider to simply list the time documentation sentence, and exclude History, Exam and Medical Decision Making. An E/M visit still requires those three components, however the purpose of proper time documentation is to give the provide credit for time spent with the patient, all in the name of medical necessity.


Hope that helps and clarifies!
 

kdlberg

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I make my providers be a little more specific with what they talk about with the patient. For instance "The total visit time was 40 minutes, and 25 minutes was spent discussing reduction of high risk sexual behaviors." Maybe I'm a bit paranoid, but I've experienced "You never told me that!" too many times in my own life, so something slightly more descriptive than "counseling," I feel, protects my providers.
 
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I have a subsequent inpatient (99231-99233). Dr dictates I spent a total of 55 minutes on his case; combination of direct examination and discuss in coordination with his family. Is this enough for a 99233?
 

arramire

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I have a subsequent inpatient (99231-99233). Dr dictates I spent a total of 55 minutes on his case; combination of direct examination and discuss in coordination with his family. Is this enough for a 99233?
I wouldn't think so.
The time spent has to be clearly indicated, which it is, but also that more than 50% of the encounter was spent on counseling, or coordination OF CARE. The example you have merely indicates the provider "discuss in coordination with his family" - so was he coordinating the meeting time? arranging a translator? what was the nature of his coordination? He/She is falling short in that one key area.
 
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So if he would have said A total of 55 minutes were spent face to face with the patient during this encounter and over 50% was spent on counseling and coordination of care. Would that be enough?
 

Pathos

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It can depend on the payer what they accept, but my suggestion to the providers I educate is to make their documentation as ironclad as possible. If they add what was counseled then that would only reinforce the time statement.

CMS E/M guidelines
 
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