Jen Godreau, BA, CPC, CPEDCContent Director

Inhealthcare’s Supercoderjenniferg@supercoder.com

Is This How You’re Protecting Your Time-Based Pay?http://obs.kg/video/159/Beatles-Cartoon--Money

Spot Problem in Chart EntryAn 8-year-old boy seen for ADHD (chief complaint)

FU (HPI-duration) visit. He has been on stimulant medication (HPI-modifying factor) for one month (HPI-duration) but is not doing well (HPI-quality). He is still having problems attending school (social history-education) and with off-the-wall behavior at home (HPI-severity). His parents have not noted problems with appetite (ROS-constitutional) or sleep issues (ROS-neurological or respiratory-not both). Physical examination consists of a brief neurological examination (can’t give credit here as there are no details).

Chart Entry (Cont.)Extensive counseling is done for school and

behavioral issues, his diagnosis of ADHD and treatment options (counseling description). His stimulant dosage is increased (prescription drug management-table of risk-moderate) (MDM risk: 2 pts) and FU planned in one month. Total face-to-face time is 25 minutes. (can’t use this

without knowing how much of that

time was spent counseling).

Documentation RequirementsTo code based on time, the physician

must document:the total time spent with the patientthat more than 50 percent of the face-

to-face time the physician spent with the patient/and or family is counseling/coordination of care

a description or summary of the counseling/ coordination of care.

Chart Entry ProblemRule:

CPT lets you select an office visit code based on time only when the physician spends more than 50 percent of the face-to-

face time with the patient and/or family member on

counseling and/or coordination of care

If included documentatio

n requirements,

visit would support

99214Typical time:25 minutes

No%

Protect Your PayIf documentation does not

specify that the encounter has met the more than 50 percent counseling requirement

DO NOT use time as the controlling factor to select the level of E/M service.

DO: Code based on HEM.

History-Detailed:HPI-quality, severity,

duration, modifying factors-EXTENDED

ROS-Constitutional, Neuro (or respiratory-not both)

PFSH-SocialExam-NONEMDM-Low:

Est. Problem worsening-2 pts

Data-NONERisk-Moderate

CODE: 99213

$33 per 99214 down coded to

99213

Easy Ways to Document TimeStatements such as “I spent

[counseling/coordination of care] minutes of [total] minutes on this service for [topic] visit.”

Shorthand abbreviations to represent total counseling/ coordination of care time and total time such as TC/TT: Time Counseling or Coordinating care/Total time.

45T/30C

Code RequirementsDescriptor must include timePhysician or nonphysician practitioner

depending on law and scope of practice must provide counselingAllowed providers: MD, ARNP, PA

Medicare will not cover servicesin which patient is not present

Counting Allowed MinutesOutpatient InpatientOutpatient time is face-

to-face time.You can only count time

the physician spends directly with the patient and/or family (Medicare requires patient present).

Inpatient time is floor time.When tallying hospital

time, you can include these services: looking at records talking to nurses documenting the visit writing orders in the chart making related telephone

calls.

Stay CompliantMethod 1: Code Visit Using Time

AllotmentsMedicare considers times to be minimums.Method 2: Treat Times as AveragesDocumented time must equal or exceed the

‘average’ time given to bill that level.

Times as Averages“In selecting time, the physician must have spent a time closest to the code

selected,” states CPT Assistant Aug. 2004. Following CPT Assistant’s closest time code rule, time breakdowns for office visits

include:

Code For this level, CPT descriptor indicates physicians typically spend this many minutes face-to-face with the patient and/or family

CPT Assistant indicates to use when counseling/coordination of care dominates face-to-face office time totaling this many minutes

99212 10 10-12.5

99213 15 12.6-20.5

99214 25 20.6-32.5

99215 40 32.6 or more

Compare Both Methods“I spent 35 minutes with patient, 20

minutes of which was for counseling regarding weight management, helping to formulate a diet and exercise plan.”

Method 1:When considering the time allocations as thresholds, example supports 99214.

Method 2:Select 99215 when time spent is 33 minutes or longer (AAP News July 2008).

Thank You!Contact: E-mail:

Jenniferg@supercoder.com

Other resources: Forums:

Supercoder.com/forum AAPC.com Askleslie.com Facebook.com/

supercoderpage SupercoderAlerts:

Family Practice Internal Medicine

QuestionsCan you code based on time with new

patients?Does Medicaid follow Medicare rules?

$197 Value!