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Time based code?

  1. Default Time based code?
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    Hi Everyone,
    1.)I have a Provider who codes =99205 for New= and =99214 and 99215 for EST=.because according to him he spent 2 hours always for ALL his HIV patients BUT his NOTES meets only 99203 for NEW AND 99213 for EST.?

    2.)ANOTHER SCENARIO;
    I have a Provider who told me that for ALL her FOLLOW-UP VISITS she does COUNSELING all the time in which she spent mostly 50% time from the total subsequent visit so my question is?
    IT IS OKAY FOR ALL HER SUB.VISIT LEVEL OF SERVICE CPT WILL ALL TIME BASED CODES?

    3.) LASTLY;
    IF THE LEVEL OF SERVICE CPT WILL BE BASED ON THE TIME COUNSELING SPENT COULD WE STILL ADD THE PREVENTIVE COUNSELING CODES CATEGORY ;
    99401-99404
    99406-99409
    97802-97804

    A BIG THANKS !

  2. Default
    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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