Wiki Evaluation and Management time piece

[leastratton1001]

Can anyone clarify is there are any regulations as far as time when it comes to documentation. For example- the E&M guidelines for time indicate that it is "total time on the day of encounter", but we are often seeing clinicians finish up their documentation in the EMR as late as the next day or day after. Are we allowed to utilize that time or must it only be the time spent on the actual day of encounter? I am hearing conflicting answers and cannot find anything solid except for "total time on the day of encounter" which leads me to believe if they do not finish it on the day of encounter we cannot utilize it for time.

 

[jkyles]

Hi there, you can only count time on the calendar date of the encounter. If they see the patient on August 2, they can count everything from midnight to 11:59 p.m. on 8/2.

I think this passage in the guidelines is a bit clearer.

For coding purposes, time for these services is the total time on the date of the encounter.

That makes it clear that they're talking about a calendar date, not a 24-hour period. I think there is a CPT Assistant article on this, I'll see if I can find it.

 

[leastratton1001]

Thank you! i just was not sure what to do when these practitioners are entering in their documentation late- such as 1 to 2 days after the encounter. It belongs to that encounter but its not timely.

 

[sls314]

Thank you! i just was not sure what to do when these practitioners are entering in their documentation late- such as 1 to 2 days after the encounter. It belongs to that encounter but its not timely.

I'd be concerned with that not only because of the total time, but also the quality of the documentation.

Realistically, how good is their memory of multiple encounters 1-2 days after the fact?

 

[jkyles]

Thank you! i just was not sure what to do when these practitioners are entering in their documentation late- such as 1 to 2 days after the encounter. It belongs to that encounter but its not timely.

Right. If you remind them that you can't count that documentation time toward the visit it might encourage them to finish up their documentation on the same date.

 

[leastratton1001]

That is exactly my thought process. Thank you all so much!
Somone has been telling us that they have 2 days prior and 3 days after for ALF/Home coding and 24/48 hours for inpatient visits and I cannot locate any guidance indicating such.

 

[jkyles]

That is exactly my thought process. Thank you all so much!
Somone has been telling us that they have 2 days prior and 3 days after for ALF/Home coding and 24/48 hours for inpatient visits and I cannot locate any guidance indicating such.

Ah-ha!

Medicare does allow providers to count pre-, post or pre- and post-DOS time toward some E/M visits, but only for the purposes of calculating prolonged service time. For example time for a home/residence visit can include time 3 days before and 7 days after the face-to-face encounter toward the threshold time for prolonged service code G0318.

Source: www.cms.gov/files/document/r11842cp.pdf

Some private payers may follow these rules, but you'd need to check each plan.

 

[leastratton1001]

Ah-ha!

Medicare does allow providers to count pre-, post or pre- and post-DOS time toward some E/M visits, but only for the purposes of calculating prolonged service time. For example time for a home/residence visit can include time 3 days before and 7 days after the face-to-face encounter toward the threshold time for prolonged service code G0318.

Source: www.cms.gov/files/document/r11842cp.pdf

Some private payers may follow these rules, but you'd need to check each plan.

THANK YOU!! This is exactly what I needed!!! Super helpful! cant thank you enough!!