# E/M codes for Subsequent hospital care



## mitzfritz215 (Jul 14, 2011)

The doctor I work for does rounds at the hospital.  I get a sheet with the dates and time that he spends with them.  I need to make sure that I am billing the correct codes for the time spent.  I know it requires 2 of the 3 key components.  My question is this - if the doctor spends 35 or more minutes with a Pt but the notes read that they are comfortable with no acute distress and he took vitals, reviewed blood work results, x-rays and was on the floor/unit do I only bill for 15 minutes since the Pt is stable, recovering or improving?  I think I should only be billing 99231 but how can the doctor be paid for the extra time?  Sometimes he's with the Pt's for a very long time.
Thanks


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## DeeCPC (Jul 14, 2011)

Hospital time is 'floor time' which includes time with patient, discussions with other providers/staff and reviewing test results.  This could take 35 minutes.  I would question this if every patient is the same code or length of time.  I educate my providers that they should describe the time spent.


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## mitzfritz215 (Jul 15, 2011)

Thank you for your response.  His times are all different but I wanted to make sure I could bill 99233 if he spent over 35 minutes.  Sometimes he is with them for over an hour.  These are very ill patients that are nearing death (cancer, renal failure, CHF, etc.) so he spends a lot of time with them.  The doctor I work for works long hours.  Our office is open from 10-10 and he works later than 10 up to 2:30 in the morning, weekends and holidays.  I am trying to find a way for him to be paid for his time. He is such a caring and dedicated doctor.  I got lucky and work for a wonderful doctor so I want to help him as much as I can.


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## LindaEV (Jul 15, 2011)

Please remember that time should not always be a contributing factor for the code selection. His documentation should reflect _why_ he spent so much time if you are going to code based on the time rule. He sounds like a great doctor...I'd hate to see him get targeted for billing too many high levels without documentation to support it....with as ill as his patients are, it shouldn't be that hard.


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## FTessaBartels (Jul 15, 2011)

*Counselling/Coordination of care*

You can use time spent ONLY when more than 50% of the total time spent was for counseling / coordination of care. 

In order to bill based on time spent in counseling/coordination of care, the physician* MUST *specificallly document* ALL three *of the following:
1) total time spent
2) time spent in counseling/coordination of care (must be MORE than 50% of total time)
3) nature of the counseling/coordination of care (i.e. a summary statement of what was discussed)

If these three elements are not met, then you code based on documentation meeting the key elements (History, Exam, MDM).

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## DeeCPC (Jul 15, 2011)

There is a distinction between inpatient and out patient time spent.  'Total time spent ' could be misleading.

Outpatient visits must be >50% of face-to-face time spent in counseling/coordination of care and then >50% of inpatient floor time must be spent in ccc.

http://www.cms.gov/manuals/downloads/clm104c12.pdf


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