# time based



## krssy70 (Jul 15, 2010)

Hello,

I have a physician in our group that persistantly documents time for all his encounters. What are your thoughts on utilizing time for every patient for a physician. He does also document, HPI, EXAM, and an assesment/Plan. But I am not sure which I should be utilizing. Elements or Time??? 

Thanks


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## cheermom68 (Jul 15, 2010)

Time can only be used to determine level selection if >50% is spent in counseling and/or coordination of care(and documented as such).  I would doubt all of his encounters would fit into this category.  I advise the physicians that I talk to to use time for level determination discriminatively.  I believe that in an audit the use of time exclusively would be a red flag.  Some specialties would be more likely to be able to use time, such as psychiatry, maternal-fetal medicine etc. perhaps.


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## krssy70 (Jul 16, 2010)

Thank you for your response. The physician is a GYN Oncologist and all his patients are being diagnosed with cancer. So it is possible for him to spend a signifigant amount of time with them in counseling, due to the patients are beginning a regimen of chemotherapy or are already being treated with chemo. He specifically documents exactly that he is spending 50% of time with couseling and coordination of care. He does his HPI< and EXAM< and Assesment. These patients are not new patients, they are already established in our facility. I noticed that any New patients or consults are not dictated this way. So it would only be the established patients that he is coding this way. 

Do you still feel that it would be a red flag?? I apologize that I didn't give the detail perviously in my question.. 

Thanks again for your input.


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## SThebarge (Jul 19, 2010)

I work for a hematology/oncology office and we have some docs that do a lot of time based coding.  As long as it is being documented correctly per CMS guidelines...Total time spent with patient, total time spent in counseling, and description of what was counseled or care coordinated, I think you should be fine.  For Oncology, the docs spend a lot of time discussing treatment planning/changing, symptoms related to chemotx, toxicities or data with the patients and their family; so if they do document the time factor that's how you should code it.  As far as red flags go just make sure they follow those rules regarding documentation on time.


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## nikita0872 (Jul 20, 2010)

*time based and prolonged services*

I have having almost the same issue...not only are our providers using time as a factor but they want to use prolonged services face to face time (CPT 99354).  I have been trying to explain how to document this correctly if they want the credit for it but they are having a hard time understanding.  
Does anyone have a good example of a providers note that I can show them when they are using time as a factor for the E&M plus prolonged services?
Thank you!


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## mitchellde (Jul 20, 2010)

heatherw4100 said:


> I have having almost the same issue...not only are our providers using time as a factor but they want to use prolonged services face to face time (CPT 99354).  I have been trying to explain how to document this correctly if they want the credit for it but they are having a hard time understanding.
> Does anyone have a good example of a providers note that I can show them when they are using time as a factor for the E&M plus prolonged services?
> Thank you!



Prolonged time is in addition to a visit level.  They must document total time spent with the patient face to face, anytime the physician is out of the room does not count.  Some payers want this as a time in and time style.  The visit must then be leveled out according to 95/97 guidelines to whatever level is met.  Then you subtract the time for that level (this is in the CPT book) from the total time spent and if the remaining time is 30 minutes or greater you may append prolonged time.  The diagnosis you have should support this type of encounter and certainly it should not be for every patient.  Also the more patients you have prolonged time with, the fewer total patients your physician will see in a day.


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## nikita0872 (Jul 21, 2010)

Thank you Debra but I already explained all that to them.  I just thought maybe someone had an actual providers note that I can show to them as an example of how to document it. Our providers are just not getting it.


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