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Billing Based on Time

  1. Default Billing Based on Time
    Medical Coding Books
    I have a question on how to code for an E/M service based on time when 50% or more of the time is spent counseling or coordinating care.

    Here is my example:
    A physician sees an established patient and documents a level 3 service based on the 3 key components. At the end of the visit the patient states she is concerned about depression. The physician spends 16 minutes counseling the patient on depression, signs, symptoms and treatment options. Can the physician assign the "typical time" associated with the documented 99213 added to the documented counseling time and select the E/M code based on the Total time of 31 minutes:
    Documented visit 99213= 15 minutes
    Documented counseling time= 16 minutes
    Total Time spent = 31 minues = 99214
    OR

    should the physician document the "Actual total visit time" with the patient? (the code would then be selected based on that actual total time; if the counseling time was more than 50% of the actual total time.)

  2. #2
    Default
    If the physician wants to bill based on time because the counseling was for more than 50% of the visit, the physician needs to state the total face-to-face time (the actual total time, not the 'typical time' for the E/M), the counseling time and a brief synopsis of what the counseling was for. They may have spent more that the 'typical time' with the patient so could get credit for it.
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    National Advisory Board Member 2018-2021, Region 6 Great Lakes
    Minneapolis AAPC Chapter, Education Officer 2018
    AHIMA ICD-10-CM/PCS Trainer
    AAPC National ICD-10 Trainer

  3. #3
    Location
    Woodland Hills, CA
    Posts
    121
    Smile
    Quote Originally Posted by maryan611 View Post
    I have a question on how to code for an E/M service based on time when 50% or more of the time is spent counseling or coordinating care.

    Here is my example:
    A physician sees an established patient and documents a level 3 service based on the 3 key components. At the end of the visit the patient states she is concerned about depression. The physician spends 16 minutes counseling the patient on depression, signs, symptoms and treatment options. Can the physician assign the "typical time" associated with the documented 99213 added to the documented counseling time and select the E/M code based on the Total time of 31 minutes:
    Documented visit 99213= 15 minutes
    Documented counseling time= 16 minutes
    Total Time spent = 31 minues = 99214
    OR

    should the physician document the "Actual total visit time" with the patient? (the code would then be selected based on that actual total time; if the counseling time was more than 50% of the actual total time.)
    In order to code a visit based on time, the total visit time and the counseling time MUST be documented.
    For example, the total time was 40 minutes and 30 minutes was the counseling. In this case, if the pt was established, the code would be 99215.

    Hope, this helps.
    Lilit
    CPC CCS
    "The true way to render ourselves happy is to love our work and find in it our pleasure."

  4. #4
    Location
    Milwaukee WI
    Posts
    4,466
    Default Your second option
    Maryann, you ask ...
    OR
    should the physician document the "Actual total visit time" with the patient? (the code would then be selected based on that actual total time; if the counseling time was more than 50% of the actual total time.)


    Yes, that's what the physician should do.
    1) document total face-to-face time
    2) document amount of time spent counseling/coordinating care (can give actual time OR percentage, as long as MORE than 50%of total time is spent in C&C)
    3) State what counseling was about.

    For example: "I spent 30 minutes with patient today, 20 minutes of which was counseling regarding her concerns about depression, signs/symptoms and treatment options."

    F Tessa Bartels, CPC, CPC-E/M

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