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What is your opinion?

  1. Exclamation What is your opinion?
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    I have a provider that wants to code solely based on time for all of our Accutane followups for acne that is treated with a high toxicity medication. These visits are typically 15 minutes a visit sometimes longer. Does anyone know if it is allowed by Medicare guidelines that each and every visit can be coded based on time. (not using 99354, only code the visit on time bypassing all specific documentation requirements for history, exam and medical decision making) I hope I made this clear for everyone

    Thank you,

    dscoder74 CPC

  2. #2
    I have a couple of providers that code strictly on time. I am not aware of anything restricting the number of visits you can bill based on time.

    I do know it is driven by medical necessity and I have posted a question on E/M university regarding how to determine medical necessity when the visit is time based.

    The scenario I run into is my provider spends 80minutes on a consult but the MDM is only moderate not high.

    It sounds like you will have a similar scenario and it will be interesting to see what everyone else is running into.

    Laura, CPC

  3. #3
    Milwaukee WI
    Default He may be cheating himself
    15 minutes spent face-to-face, with more than 50% in counseling/coordination of care equals 99213.

    The requirements for this code are two of the three following:
    History - Ex Prob Foc
    Exam - Ex Prob Foc
    MDM - Low

    Or maybe your provider is thinking that MDM should be moderate or even high because of the Acutane? Bear in mind that risk factor is only ONE component of MDM ... you still would need to have either data points or problem points to reach the moderate or high MDM level. Could this be why s/he wants to bill based on time spent?

    To correctly bill based on time, more than 50% of the total time spent should involve counseling and/or coordination of care. The note needs to reflect the total time spent face-to-face, the amount of that time that was spent in counseling/coordination of care, and the nature of the counseling. It is NOT enough to simply state "time spent with patient 15 minutes."

    F Tessa Bartels, CPC, CPC-E/M
    Last edited by FTessaBartels; 01-07-2009 at 04:10 AM.

  4. #4
    Salt Lake North
    Coding based on time is used when you can't meet the three key components. Maybe a patient came in with concerns about a new medication that has been prescribed and the physician reviews the Rx, its proper use and what to expect and side effects. Since the physician will not do a HX, Exam and so forth, he can bill based on the amount of time spent reviewing the medication with the patient. The time needs to be documented as well as what was discussed. A doc can also do this when they are co-ordinating care with other providers.

  5. Default
    Hi Tessa and everyone that responded. This is the situation...My provider does not agree with me that an Accutane follow up, when the problem is stable (1 problem point) for acne, examined always up to 3 body areas sometimes 4, monitoring labs (1 problem point) and refilling on the medication. I always see this as a 99212. If this problem was worsening I would give credit of 99213. So in this case this provider wants to shoot for a 99213 for EVERY one of these visits only based on time and to bypass all required for an E/M. What are your thoughts!!!!



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