Cindy Posted Sat 02nd of March, 2019 11:45:04 AM
My physician noted in his records A 16-year-old female with acne on face. Slightly elevated AST at 43, cholesterol 207. This is at 40 mg Isotretinoin. We will decrease to 20 mg. Negative depression. Abstinence. Negative urine pregnancy. Risks and benefits, pros and cons reviewed. Total 25-minute visit, greater than half in consultation. We are having a disagreement about this. He wants to code 99214 based on the 25 minutes and more than half time spent consulting. I think that since he did not detail the nature of the counseling he cannot used time based coding. I would like your advice on this matter.thank you
SuperCoder Answered Tue 05th of March, 2019 03:22:21 AM
Before using time as the controlling factor, check off the following requirements that must be documented:
(A) The total time spent with the patient
(B) that more than 50 percent of the face-to-face time the physician spent with the patient/and or family is counseling/coordination of care. For instance, “Saw the patient for 25 minutes face-to-face; 20 minutes of that visit was spent in counseling.”
(C) a description or summary of the counseling/coordination of care provided. For the example above, you could consider, “Done to address coping strategies for the patient’s diagnosis of overactive bladder and treatment options.”
As per the Medicare Claims Processing Manual, Chapter 12, Section 30.6.1.C states: “The code selection is based on the total time of the face-to-face encounter or floor time, not just the counseling time. The medical record must be documented in sufficient detail to justify the selection of the specific code if time is the basis for selection of the code,”.
“Provider documentation such as ‘I had a lengthy discussion...’ or ‘I spent a great deal of time with the patient discussing...’ does not support using the dominant counseling/coordination of care as the basis for level of E/M service,”.
You should only select an office visit code based on time when your 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.
Please check the below link for better understanding:
Cindy Posted Tue 05th of March, 2019 06:52:53 AM
I understand what time based coding means, I am asking you if you think his statement would support the counseling part of it. I have used time based coding with my providers for years, but I don't feel his statement satisfies the counseling part of it. Please re-read my question.
Cindy Posted Tue 05th of March, 2019 06:59:59 AM
Also, I do not have access to this link. It states I don't have this subscription so this doesn't help me any.
SuperCoder Answered Wed 06th of March, 2019 05:12:12 AM
As per guidelines, when code selection is based on the total time, then face-to-face encounter or floor time matters, not just the counseling time. The medical record must be documented in sufficient detail to justify the selection of the specific code if time is the basis for selection of the code. The actual language required for code is “Patient’s counseling and/or coordination of care with physicians. Typically, 25 minutes are spent face-to-face with the patient and/or family”.
However, face-to-face time includes not only the time spent counseling but also the time associated with any history, exam or medical decision making that you perform. The time you spend reviewing records, talking with other providers and documenting the encounter without the patient or family present cannot be considered. So, the word COUNSELING and/or COORDINATION is important, whereas it totally depends on the payer how they consider when using word CONSULTING. It is suggested to check with your payer for the pattern of document they usually require. On the other hand, you can still add an addendum by the serving physician into the EM Report with required modified language.