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E/M codes for Subsequent hospital care

  1. Default E/M codes for Subsequent hospital care
    Medical Coding Books
    The doctor I work for does rounds at the hospital. I get a sheet with the dates and time that he spends with them. I need to make sure that I am billing the correct codes for the time spent. I know it requires 2 of the 3 key components. My question is this - if the doctor spends 35 or more minutes with a Pt but the notes read that they are comfortable with no acute distress and he took vitals, reviewed blood work results, x-rays and was on the floor/unit do I only bill for 15 minutes since the Pt is stable, recovering or improving? I think I should only be billing 99231 but how can the doctor be paid for the extra time? Sometimes he's with the Pt's for a very long time.
    Thanks

  2. Default
    Hospital time is 'floor time' which includes time with patient, discussions with other providers/staff and reviewing test results. This could take 35 minutes. I would question this if every patient is the same code or length of time. I educate my providers that they should describe the time spent.
    Dee
    CPC, CPCO, CPMA, CPCD

  3. Default
    Thank you for your response. His times are all different but I wanted to make sure I could bill 99233 if he spent over 35 minutes. Sometimes he is with them for over an hour. These are very ill patients that are nearing death (cancer, renal failure, CHF, etc.) so he spends a lot of time with them. The doctor I work for works long hours. Our office is open from 10-10 and he works later than 10 up to 2:30 in the morning, weekends and holidays. I am trying to find a way for him to be paid for his time. He is such a caring and dedicated doctor. I got lucky and work for a wonderful doctor so I want to help him as much as I can.

  4. #4
    Location
    Kansas City, MO
    Posts
    431
    Default
    Please remember that time should not always be a contributing factor for the code selection. His documentation should reflect why he spent so much time if you are going to code based on the time rule. He sounds like a great doctor...I'd hate to see him get targeted for billing too many high levels without documentation to support it....with as ill as his patients are, it shouldn't be that hard.
    Linda Vargas, CPC, CPCO, CPMA, CPC-I, CEMC,CCC
    PMCC Licensed Instructor
    Kansas City, MO Chapter
    President, 2018
    Vice President, 2017
    Member Development Officer 2016
    Harrisonville, MO Chapter President - 2013
    ICD-10 Education Coordinator- 2012
    Chapter President - 2011
    President Elect - 2010

  5. #5
    Location
    Milwaukee WI
    Posts
    4,466
    Default Counselling/Coordination of care
    You can use time spent ONLY when more than 50% of the total time spent was for counseling / coordination of care.

    In order to bill based on time spent in counseling/coordination of care, the physician MUST specificallly document ALL three of the following:
    1) total time spent
    2) time spent in counseling/coordination of care (must be MORE than 50% of total time)
    3) nature of the counseling/coordination of care (i.e. a summary statement of what was discussed)

    If these three elements are not met, then you code based on documentation meeting the key elements (History, Exam, MDM).

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  6. Default
    There is a distinction between inpatient and out patient time spent. 'Total time spent ' could be misleading.

    Outpatient visits must be >50% of face-to-face time spent in counseling/coordination of care and then >50% of inpatient floor time must be spent in ccc.

    http://www.cms.gov/manuals/downloads/clm104c12.pdf
    Dee
    CPC, CPCO, CPMA, CPCD

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