I would be very, very careful about billing all of their e&m's using time based criteria. I have heard of circumstances in which the Medicare carrier has requested copies of the provider's schedule because unless they only see 4 patients a day I would find it hard to believe that they are spending that much time with the patient. They have to spend more than 50% of the office visit on counseling or coordination of care and it has to be face to face time with the patient. They are also setting themselves up to be audited because they are making themselves outliers by using this many high level codes.
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