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Time based E/M Billing

  1. #1
    Default Time based E/M Billing
    Medical Coding Books
    I originally posted this in the Behavioral Health Thread since we are an Community Mental Health Center, but was hoping to recieve more input here possibly. Thanks for your input in advance

    We would like to start using the time based E/M billing, I have a quick question. Both the 1995 and 1997 CMS guidelines state that:

    D. DOCUMENTATION OF AN ENCOUNTER DOMINATED BY COUNSELING OR COORDINATION OF CARE
    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.


    I am unsure whether or not we would still need to meet the 3/3 or 2/3 guidelines as far as history, exam, MDM, etc... I have been unable to find a definitive answer anywhere.

    As long as we document total face to face time with client in counseling and/or coordination of care, as well as medications/care discussed, what else do we need to document on each visit?

  2. #2
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    North Carolina
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    Default
    Does this help?

    "Advise physicians that when counseling and/or coordination of care dominates (more than 50 percent) the face-to-face physician/patient encounter or the floor time (in the case of inpatient services), time is the key or controlling factor in selecting the level of service. In general, to bill an E/M code, the physician must complete at least 2 out of 3 criteria applicable to the type/level of service provided. However, the physician may document time spent with the patient in conjunction with the medical decision-making involved and a description of the coordination of care or counseling provided. Documentation must be in sufficient detail to support the claim."

    This implies that time is the controlling factor...

    30.6.1 C

    http://www.cms.gov/manuals/downloads/clm104c12.pdf


    CPT Assistant 1991:

    "The content of the service is used to select the appropriate level of E/M service. In the case where counseling and/or coordination of care dominates (more than 50%) the face-to-face physician/patient encounter, then time is considered the key or controlling factor. The extent of counseling and/or coordination of care must be documented in the medical record."

    CPT Assist 1992:

    .......The exception to selecting a code based on which two or three key components were met or exceeded, is when counseling and/or coordination of care dominates (more than 50%) the face-to-face physician/ patient encounter; then time is considered the key or controlling factor to qualify for a particular level of E/M services. The code selected for this encounter is selected based on the total time of the face-to-face physician/patient encounter. The extent of counseling and/or coordination of care must be documented in the medical record.

    Example:

    The total time Dr. "A" spent with Mrs. Smith was forty minutes; thirty minutes of this time were spent counseling. Code 99215 would be reported, based on the total time spent face-to-face by Dr. "A" with Mrs. Smith. Dr. "A's" documentation should indicate the extent of the counseling he provided at this encounter. (Note: Doctor "A" did not perform two of the three key components required to report code 99215. Because counseling dominated the face-to-face physician/patient encounter, time is considered the controlling factor to qualify for this level of service. Code 99215 was selected because the total time spent with Mrs. Smith (an established patient seen in his office) was 40 minutes.)

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