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coding based on time

  1. #1
    Default coding based on time
    Medical Coding Books
    I understand the logic of time used for coding E/M . The problem I have is that our practice would like to use the time without out reaching all 3 components for the level. Do anyone have documentation that supports either way

    eg: Our clinican does not provide a comprehensive History for 99305 but spent more then 50% of the time counseling pt. Could time be used in this case???

  2. Default
    When billing based on time, the provider does not need to cover the 3 key components as long as the majority of the visit (> 50%) was spent in counseling and/or coordinating care.

    In your example, the provider would need to document total time of the visit and state that greater than 50% was spent counseling the patient. He/She would also have to document what was discussed with the patient.

    To bill 99305, the total visit must be at least 35 minutes long.

    Medicare's National Coverage Provision - subject # PHYS-001 discusses billing on time.

    Lisi, CPC

  3. #3
    Default Time Based Coding
    When a provider provides 50% or more face-to-face counseling or coordination of care he/she may elect to bill "Based on Time alone". There is required documentation for billing this way.
    1. The provider must document "time spent counseling/time total for intire visit" on the progress note. Example: 20/30 minutes. The provider spent 20 minutes of a 30 minute visit counseling the patient.
    2. The provider must document in detail what he/she counseled with the patient. This must be more than a few sentences.
    3. The fee ticket must be marked by the provider "Time Based Counseling" and document the time again 20/30 minutes.
    Insurance carriers want to see the work performed when billing this way. Coding this way is not appropriate for every visit, but definatly when the provider is spending 50% or more of the face-to-face time counseling.
    When billing this way all of the required documentation must be meet to support this type of billing.
    KSS, CPC

  4. #4
    Default
    Hi ksimp_auditor, can I ask where you got your info, I am looking for something that does state what #2 is. I knew there had to be detail and I am running into that problem with my providers. Also, I have providers who are constantly using Time and not it is becoming apparent that it is inappropiate much of the time. Do you have a resource for me?

  5. #5
    Default
    Thanks everyone,

    Our complaince team is working on the documentation aspect of the time based coding. I wasn't sure if the time can be a major factor over the key elements. My concern is that I had to rely on providers making a judgement on the time spent (knowing that they can get paid more).


    Thanks again!!!

  6. Default Time based guidelines
    Quote Originally Posted by coder1 View Post
    I understand the logic of time used for coding E/M . The problem I have is that our practice would like to use the time without out reaching all 3 components for the level. Do anyone have documentation that supports either way

    eg: Our clinican does not provide a comprehensive History for 99305 but spent more then 50% of the time counseling pt. Could time be used in this case???
    I do not agree with all the responses here. Making the physician indicate that it should be a time based visit does not reflect the information we have from WPS. Nor do they state how many sentences are needed. You can read their Q&A by clicking on the link. I did quote one answer here in the text.

    Here is the link to the Time-based Coding Q&A from WPS (our medicare contractor)
    http://www.wpsmedicare.com/part_b/ed...imebased.shtml
    Q:How does a provider determine whether to use the level of history, exam, and medical decision making versus the counseling/coordination of care based on time?
    A5. Code the service based on the three key elements (history, exam, and medical decision-making) and then on time when counseling/coordination of care is an option. Then you want to choose the procedure that is the most advantageous for you.

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