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Preventative and seperate E/M code

  1. #1
    Location
    Idaho Falls, Idaho
    Posts
    197
    Default Preventative and seperate E/M code
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    Hi
    I have a provider that did a annual exam, but then spent 45 mins discussing a seperate problem. He documented the 45 mins in the annual note, and what he discussed, and wants to bill a 99395 and a 99214. I know it is possible if they document the 3 key components for a seperate 99214, but can we bill it based off time?
    Thanks for any help.
    Tesja Erickson, CPC, CPMA COBGC, CEMC
    The Coding Surgeon
    Medical Documentation & Coding Consultant
    codingsurgeon@tesja.com
    2012 AAPC Idaho Falls Chapter President
    2011 AAPC Idaho Falls Chapter President-Elect

  2. #2
    Location
    North Carolina
    Posts
    3,126
    Default
    With thorough documentation, it is possible to bill based on time for the problem oriented visit if the physicians face-to-face encounter indicates that over half was spent in counseling and coordination of care.

    Example: I spent over 50% of a total _____minutes counseling/ coordinating care and document the substance of the discussion.

  3. #3
    Default Preventative w/Eval and Management
    Having audited preventative services I would question if the patient was well enough to have been considered routine or if he/she should have been scheduled for their preventative care at a later date.

  4. Default
    "......but then spent 45 mins discussing a seperate problem....."

    For this 45 minutes to meet the 50% guideline that means he would have had to be face-to-tace with the patient 90 minutes. Is that what he did?

    The 9938x-9939x are not defined by time and the 99214 is defined as 25 minutes

    Maybe I am not understanding the question

  5. #5
    Location
    North Carolina
    Posts
    3,126
    Default
    I took it to mean that the provider provided a wellness exam and then a separate, identifiable problem oriented service was also provided.

    CPT Assistant states:

    “When counseling and/or coordination of care constitute more than 50% of the physician/patient and/or family encounter (face-to-face time in the office or other outpatient setting or unit/floor time in the hospital or nursing facility) time may be considered the key or controlling factor to qualify for a particular level of E/M service.”

    "If counseling and/or coordination of care did dominate the visit, then the code is selected based on the total time of the face-to-face physician/ patient (and/or caregiver) encounter (or total floor/unit time in the hospital or nursing facility setting). It is important to note that not all codes have typical times (eg, domicilliary care). In such cases, time may not be used to select the code. In selecting time, the physician must have spent a time closest to the code selected. For example, 99214 has a typical time of 25 minutes and 99213 has a typical time of 15 minutes. If the face-to-face office time is 21 minutes, code 99214 would be selected as it is more than half of the time difference."

    Example:

    Physician A discusses insulin-dependent diabetes with the patient, reviewing the importance of diet and exercise, proper insulin administration, and the home management of hypoglycemic reactions. The total time Physician A spends with Mrs Smith is 25 minutes, 15 minutes of which is counseling. Although Physician A performed all three of the key components, counseling clearly dominated the service and can be considered the controlling factor. In this example, it would be appropriate to report code 99214 based on the total 25 minutes spent face-to-face by Physician A with Mrs Smith, of which more than half was spent counseling. Of course, Physician A's documentation should indicate both the extent of the counseling he provided at this encounter as well as the total time and the time counseling during the visit.

  6. #6
    Location
    Idaho Falls, Idaho
    Posts
    197
    Default
    He actually spent 45 extra mins on top of the preventative visit. So 100% of the 99214 was spent counseling. Thanks for everyone's help!
    Tesja Erickson, CPC, CPMA COBGC, CEMC
    The Coding Surgeon
    Medical Documentation & Coding Consultant
    codingsurgeon@tesja.com
    2012 AAPC Idaho Falls Chapter President
    2011 AAPC Idaho Falls Chapter President-Elect

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