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Billing Based on Time

  1. Default Billing Based on Time
    Medical Coding Books
    Absolute Brain Fart time here

    established office visit

    60 min spent face to face with patient
    20 min spent in counseling

    Because only 40 min are needed for 99215, do I use 99215? Or do I level the documentation (213 in this case) and add prolonged services to it?

  2. #2
    Here is some info from our FI. This is right from their billing guidelines for E&M form New England hope this hope this helps

    Counseling and/or Coordination of Care (Time-Based)
    When an E/M service is dominated by counseling and/or coordination of care (the counseling
    and/or coordination of care represents more than 50% of the total time with the patient) in a faceto-
    face encounter between the physician or NPP and the patient in the office/clinic or the floor
    time (in the scenario of an inpatient service), then the E/M code is selected based on the
    typical/average time associated with the code levels. The time approximation must meet or
    exceed the specific CPT code billed (determined by the typical/average time associated with the
    E/M code) and should not be “rounded” to the next higher level. In those E/M services in which
    the code level is selected based on time, prolonged services may only be reported with the
    highest code level in that family of codes as the companion code.
    Good luck

    Robin Ingalls-Fitzgerald CCS, CPC, FCS, CEMC

  3. Default
    i dont know if this is exactly what i was looking for. can anyone else help?

  4. #4
    Quote Originally Posted by renifejn View Post
    Absolute Brain Fart time here

    established office visit

    60 min spent face to face with patient
    20 min spent in counseling

    Because only 40 min are needed for 99215, do I use 99215? Or do I level the documentation (213 in this case) and add prolonged services to it?
    You pose a good question! In my opinion and from what I am reading from my local Medicare carrier it states that "If the physician documents total time and suggest that counseling or cc dominates more than 50% of the encounter, time may determine the level of service.

    And according to what you have documented I don't think you'd bill a 99215 because 20 minutes is not 50% of the total visit. I understand where your coming from with the 40 minutes comment but those are just "estimates of time".

    If your physician would have stated that 60 minutes was the total time and 30 minutes was counseling or CC then yes I would bill a level five.
    Roxanne Thames CPC, CPC-I, CEMC

    "Remember the greatest gift is not found in the store but in the heart of true friends"

  5. #5
    What was the counseling about? Could you possibly support the 99213 and 99401?

    Just a thought,

    Laura, CPC

  6. Default
    no, 401 wouldnt work. counseling was for a genetic disease, testing, outcomes, etc

  7. #7
    Mobile, Alabama
    Since time did not dominate the visit, it would not be appropriate to code the service based solely on time (if time did dominate the total visit, you would use only the 99215 because the additional 20 minutes would not be enough to add on prolonged care). You would code this visit according to the key elements documented; or 99213 per your review. Since a 99213 average time is 15 minutes, then that does leave the remaining time spent - 45 minutes - to account for and bill. In this case, I would agree that yes, prolonged care would be the appropriate code to use in addition to the 99213 because what was provided was beyond the service usually provided for that level of E/M. Because the additional time was more than 30 minutes but not over 74 minutes, the prolonged care code would be 99354.

    "Not everything that counts can be counted, and not everything that can be counted counts". ~ Albert Einstein

    Barbara Burgess, RN, CPC, ACS-EM, PCS
    Last edited by Barbara Burgess; 04-09-2009 at 10:53 AM. Reason: clarification

  8. #8
    Milwaukee WI
    Default Prolonged
    You would code the level of service as documented per the key elements (history, exam, MDM). Then you would figure out how much MORE time was spent than typical for that level of service, and if the remainder is at least 30 minutes you would use the appropriate prolonged service code.

    The reason you cannot bill based on counseling/coordination of care time is that your time spent in counseling is not more than 50% of the total time spent face to face with the patient.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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