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Time Based EM Medical Coding

Time Based EM Medical Coding

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Published by Supercoder
http://supercoder.com If you are in the medical coding industry this is a must see PowerPoint. These are the slides from Jennifer Godreau, BA, CPC, CPEDC, presentation 2/24/2010 on: Time Based EM Coding: Capture Higher Levels Without Paybacks

Coding expert Jennifer Godreau gives the lowdown on time-based office visit coding.
* Easy ways to document time visits.
* Before using time as the controlling factor, check off these requirements.
* Jennifer will give you tips on choosing your time tallying method to stay compliant.
http://supercoder.com If you are in the medical coding industry this is a must see PowerPoint. These are the slides from Jennifer Godreau, BA, CPC, CPEDC, presentation 2/24/2010 on: Time Based EM Coding: Capture Higher Levels Without Paybacks

Coding expert Jennifer Godreau gives the lowdown on time-based office visit coding.
* Easy ways to document time visits.
* Before using time as the controlling factor, check off these requirements.
* Jennifer will give you tips on choosing your time tallying method to stay compliant.

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Published by: Supercoder on Feb 24, 2010
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07/08/2012

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Jen Godreau, BA, CPC, CPEDC

Content Director Inhealthcare’s Supercoder jenniferg@supercoder.com

Is This How You’re Protecting Your TimeBased Pay?
http://obs.kg/video/159/B eatles-Cartoon--Money

Spot Problem in Chart Entry
An 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-toface time is 25 minutes. (can’t use this without knowing how much of that time was spent counseling).

Documentation Requirements
To code based on time, the physician must document: the total time spent with the patient that more than 50 percent of the face-toface 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 Problem

No %

If included Rule: documentatio CPT lets you select an office visit n code based on time only when requirements, the physician spends more visit would than 50 percent of the facesupport to-face time with the patient 99214 and/or family member on Typical counseling and/or time: coordination of care
25 minutes

Protect Your Pay
If 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-Social  Exam-NONE  MDM-Low:  Est. Problem worsening-2 pts  Data-NONE  Risk-Moderate  CODE: 99213

$33 per 99214 down coded to 99213

Easy Ways to Document Time
Statements 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 Requirements
Descriptor must include time Physician or nonphysician practitioner

depending on law and scope of practice must provide counseling
Allowed providers: MD, ARNP, PA

Medicare will not cover services in which patient is not present

Counting Allowed Minutes
Outpatient
Outpatient time is face-

Inpatient
 Inpatient time is floor time.  When tallying hospital time,

to-face time. You can only count time the physician spends directly with the patient and/or family (Medicare requires patient present).

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

calls.

Stay Compliant
Method 1: Code Visit Using Time Allotments Medicare considers times to be minimums. Method 2: Treat Times as Averages Documented 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-toface 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 10-12.5 12.6-20.5 20.6-32.5 32.6 or more

99212 10 99213 15 99214 25 99215 40

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/supercoderpa

ge

 SupercoderAlerts:
 Family Practice  Internal Medicine

Questions
Can you code based on time with new

patients? Does Medicaid follow Medicare rules?

$197 Value!

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