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Coding based on Time

  1. Default Coding based on Time
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    Requesting clarification. When auditing and providers are coding based on Time. The Medicare scorecards indicate Average time. Does that mean that if the provider documents that 50% of the time was spent in counseling and time spent is 20 minutes does qualify as a 99214? would appreciate any advice or direction where I can get written documentation to support appropriate coding.
    Thank you,
    Maria CPC

  2. #2
    Hi There,

    Refer to the last paragraph of the 1995 medicare guideline.

    In the case where counseling and/or coordination of care dominates (more than 50%) of the
    physician/patient and/or family encounter (face-to-face time in the office or other outpatient setting or
    floor/unit time in the hospital or nursing facility), time is considered the key or controlling factor to
    qualify for a particular level of E/M services.
    !DG: If the physician elects to report the level of service based on counseling
    and/or coordination of care, the total length of time of the encounter (face-to-face or
    floor time, as appropriate) should be documented and the record should describe
    the counseling and/or activities to coordinate care.

    If it is supported according to this you may bill for the alloted time for the given face-to-face time given for each E&M code.

    Hope this helps,

    The Oracle

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