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Thread: Coding E&M based on time

  1. #1

    Default Coding E&M based on time

    AAPC: Back to School
    Does anyone know of anything in writing that says a physician can not always bill an E&M based on time? An example is a physician who says he always counsels his patients therefore he should always be able to bill based on time and includes a time statement with every E&M. Is this accaptable from a compliance standpoint?

  2. #2
    Join Date
    Apr 2007
    Kingsport, TN


    In CPT there is NOTHING that says a physician cannot bill based on time, all the time. As long as his/her "FACE TO FACE" time is what is considered, and he is documenting these times, then he can bill ALL his/her patients based on time. Unless there is something I have missed, your provider is right but they cannot count non face-to-face time when choosing the E&M, it MUST be "face-to-face" time and this is according to CPT. Just my thoughts.

  3. #3
    Join Date
    Apr 2007
    Columbia, MO


    In order to bill based on time, for time to be the key and controlling component to establish the visit level, the provider must document total time spent face to face with the patient and that couseling or coordination of time took place, the counseling time must then be more than 50% of entire time spent. I show this by first establishing the visit level based on the guidelines, then take that level and subtract the time from total time spent the time left over is the counseling time which must be more than 50% of the entire time spent. I know some do it differently but this way I know I have met the requirement for time based billing.
    For example if the provider documents 25 minutes spent with the patient and meets the criteria for a 99213. you take the 15 minutes for a level 3 and subtract from the 25 total minutes to get 10 minutes for the counseling, but since 10 is not more than 50 % of 25 the visit is left as a level 3, the counseling is simply part of the encounter.
    Last edited by mitchellde; 02-17-2011 at 07:34 AM.

    Debra A. Mitchell, MSPH, CPC-H

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