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Nursing Home and Assisted Living Communities

  1. Question Nursing Home and Assisted Living Communities
    Medical Coding Books
    I have a nurse practitioner who will write on a progress note 20 minutes - 99336 or 10 minutes - 99335, you get the picture. This seems wrong to me but the nurse practitioner says that the number of minutes do not apply to nursing home and assisted living communities and she can just write down a number of minutes and it does not need to be exact. This goes against what have been taught so I am little apprehensive about entering these claims. I was also thinking if we were audited this could cause some trouble. If someone could help me with this I would appreciate.

    Dalton, CPC, CPC-P

  2. #2
    It depends on how you are billing I guess. My thought is this. These codes are codes that can be audited on levels of HX, exam and MDM. They notes should be audited out to the correct level of service.

    Now, if she wants to bill the level based on time, then no, her method of 20 min, etc is NOT sufficient. Please see page 4 of your CPT book. It defines how to code based on time. In a nutshell, she has to state the total minutes spent with patient and out of those total minutes, how many were spent face to face counseling and coordinating care. She also has to state the nature of the counseling (ie. what were they discussing). You can only choose a code based on this IF more than 50% of the minutes were spent counseling, coordinating care.

    I would not bill based on time with just her statement of 10 min, 20 min etc.

  3. #3
    Milwaukee WI
    Default Does documentation support level
    If the documentation supports the level she is choosing it does NOT make any difference how much time she spent. For example, an experienced clinician can probably perform and document a level 4 established patient visit in 10-15 minutes. Even though they would need 25 minutes if they were using counseling/coordination of time to determine the level of care.

    In fact, I'd discourage her from noting time on charts if she is coding based on meeting the key elements of documentation.

    BUT, if the NP is choosing her level of care based on time spent in counseling/coordination of care she is definitely not following the rules.

    Hope that helps,

    F Tessa Bartels, CPC, CEMC

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