what E&M level when billing negative covid test

Rfoster

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We are having to book double slots to perform covid testing and providers are all documenting total time of 25-35 minutes with each patient even with negative covid tests and diagnosis is something simple such as viral illness. Providers are concerned if they are not able to bill for the total time then they are not going to be compensated for having to see less patients due to time constraints with these visits. Can we still only bill for total time in these instances or do we still down code due to low medical necessity?
 

lcolborn

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MDM can be used . The time threshold had gone up and if E/M selection is based on time and followed the guidelines, surely you are limited to how many patients you see a day. Time sounds easy to use but if you think about it, MDM is better.
 

thomas7331

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Assuming you're talking about office E&M services, the guidelines are clear - you can use either time or MDM. It's your or your provider's choice. Do not down code due to medical necessity unless your provider or manager instructs you to do that. Coders are not trained to evaluate the medical necessity of what a provider does, and there are no published coding or audit guidelines that allow this to be done in a reliable way. Stick to the CPT rules for assigning code levels.
 

Rfoster

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Thank you for your responses! I just don't want to cause red flags to alert the payers that we're billing a flurry of 99214's for Viral Illness claims (just based on time) just due to lengthy covid testing. But providers do say they are time consuming and extra work for documentation etc. goes into all of that.
 

csperoni

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Yes, you have the option of using total clinician time or MDM for each visit.
I would just caution that I have seen providers thinking they can count time they are awaiting test results (while doing other work), or nurse time. You may only count the time personally spent by the clinician (non overlapping time of MD, DO, PA, NP, etc. day of encounter) excluding time spent on procedures. I would just look for overall red flags. Like if your docs are seeing 30-40 patients in an 8 hour shift, they clearly are not personally spending 30 minutes on each patient. Maybe a handful of those patients, but not 1/2 of them.
 
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