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billing based on time - every office visit

  1. Default billing based on time - every office visit
    Medical Coding Books
    What do you tell a physician who is submitting most of his/her office charges with the levels chosen based on time spent? Shouldn't billing based on time be the exception rather than the rule? This physician went from never billing/documenting time to now using time in every office visit. How would you approach discussing this topic with your physician?

  2. #2
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    Here's a link to an article of Betsy Nicoletti's regarding this issue.

    I'd use the article to open conversation about why it's inappropriate to use time as the determining factor in CPT selection.

    Time should only be used when "counseling and coordination of care" dominates more than 50% of the visit and when the total time, time spent counseling, and content of counseling are documented.

    http://www.mpconsulting.org/resources/HCB%20Time.pdf

    Good luck!


    Quote Originally Posted by Katkia222 View Post
    What do you tell a physician who is submitting most of his/her office charges with the levels chosen based on time spent? Shouldn't billing based on time be the exception rather than the rule? This physician went from never billing/documenting time to now using time in every office visit. How would you approach discussing this topic with your physician?

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    Thank you!

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    Quote Originally Posted by Belinda Frisch View Post
    Here's a link to an article of Betsy Nicoletti's regarding this issue.

    I'd use the article to open conversation about why it's inappropriate to use time as the determining factor in CPT selection.

    Time should only be used when "counseling and coordination of care" dominates more than 50% of the visit and when the total time, time spent counseling, and content of counseling are documented.

    http://www.mpconsulting.org/resources/HCB%20Time.pdf

    Good luck!
    Well said Belinda, Great article!
    ~Amy, CPC, CPMA, CEMC~
    Auditor/Consultant

  5. #5
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    Quote Originally Posted by Katkia222 View Post
    What do you tell a physician who is submitting most of his/her office charges with the levels chosen based on time spent? Shouldn't billing based on time be the exception rather than the rule? This physician went from never billing/documenting time to now using time in every office visit. How would you approach discussing this topic with your physician?
    To me, this is a coding issue and a practice management issue. To me, time should be an exception (others may disagree) - keep in mind, time is used when more than 50% of the encounter was spent counseling/coordinating care. Does your physician meet this criteria? It seems to me, correct me if i'm "assuming" your physician is billing based on 'time' to be 'safe' - maybe they don't feel confident in E/M coding. I would explain to them, if you document, your levels of E/M might actually be higher than based on time ....

    Practice management - does your physician have productivity that he/she has to meet? If their coding based on time, how is their schedule layed out? are they quantifying on the number of patients they can see in one day? or is time a burden?
    i.e. Dr. A can 'document' 5 patients in one hour, whereas Dr. B coding based on time could see 3 patients in an hour, 20 minutes each. In an 8 hour day, Dr. A has seen 40 patients and Dr. B has seen 24. In a normal office setting, if your seeing 20-22 patients a day, you're covering costs. Anything after, is profit. and this is important because if they are paid bonuses based on productivity, they'll listen! I could go on forever! LOL, but this is about CODING!

    Good luck!!

  6. #6
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    I'm curious...What is his/her specialty? I do agree with Belinda's article. Medical necessity is the key. One of my groups is Reproductive Medicine. The exams are minimal due to the nature of the specialty. Counseling/time based billing are his key components.

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    The physician in question is a gastroenterologist. I audited his office charges. Often, on examining his notes, I would see comments like "I spent a great deal of time counseling the patient in...." and "Lengthy discussion with patient on the natural progression of her disease." I approached the physician to ask why he was not documenting the actual time spent in counseling these patients. (He was concerned because he felt that his established patient visits should be billed at higher levels.)

    So now the physician is documenting the time spent - adding comments like "At least 50% of this visit was spent on counseling and/or coordination of care. The total visit time was: 30 minutes." However, now he is documenting MOST of his visits based on time and I was concerned.
    Last edited by Colliemom; 09-23-2008 at 08:06 AM.

  8. #8
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    North Carolina
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    I see your dilemma. Again...this boils down to medical necessity and proper documentation. I recently had an appt with my GI physician and this visit required extensive counseling. In my head, I was doing my own audit for his services. Does anyone else do that? Anyway...he did document and record the time accordingly. I don't, personally speaking, think this should be a standard for all of your physicians visits, unless medical necessity and proper documentation is in place. With Belinda's article and the CMS DG's, this should be an easy fix.

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    I appreciate everyone's help with this question. We are still trying to convince the physician that he should not be billing ALL of his office visits based on time.

    Does anyone have any links for other articles/documentation for why billing ALL office visits would be a bad idea?

    Does anyone disagree, and think it is fine to bill all the office visits based on time, as long as the physician has supporting documentation of what was discussed during the counseling?

  10. #10
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    Keep in mind that the actual statement needs to state "greater than 50%...". Stating "at least 50%" is not going to pass an audit.
    Lisa Bledsoe, CPC, CPMA

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