# Challenge scenario need help!!!ASAP



## NIEVESM (Sep 24, 2010)

Hello everyone,
I have a 70 yr.old MCR patient that was schedule for a physical examintation, oh the HPI Dr. mentioned Patient live with a sister with mental problem and sister has become violent. 

 Dr. mentioned on the plan: Unable to do physical today because discussion focused on patient living situation. 35 minutes spend counseling patient 

Dr. coded visit 99243 with V61.9 of course I have already mentioned repeatly that MCR is no longer pay for consultation codes. Now base on the time DR. time spend talking and examine patient should I bill a 99214 with the V61.9 (unspecified family circunstance)


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## rthames052006 (Sep 24, 2010)

*All time elements?*



NIEVESM said:


> Hello everyone,
> I have a 70 yr.old MCR patient that was schedule for a physical examintation, oh the HPI Dr. mentioned Patient live with a sister with mental problem and sister has become violent.
> 
> Dr. mentioned on the plan: Unable to do physical today because discussion focused on patient living situation. 35 minutes spend counseling patient
> ...



You'll need the total time spent in visit ,time spent counseling and a description of the discussion  in order to bill based on time.  If this is a new pt you can convert to a 99203, for est pt 99214 if you have the documentation to support in history, exam and MDM.

Yes-I  too would remind the docs about Medicare no longer paying for consult codes.

Hope this helps!


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## NIEVESM (Sep 24, 2010)

Roxanne thanks for your quick reply, now Dr. only listed time counseling 35 minutes does she need to separate this time from the office visit time or will this be enought to bill a 99214? She have a detailed exam and the V61.9 as new problem.


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## rthames052006 (Oct 2, 2010)

NIEVESM said:


> Roxanne thanks for your quick reply, now Dr. only listed time counseling 35 minutes does she need to separate this time from the office visit time or will this be enought to bill a 99214? She have a detailed exam and the V61.9 as new problem.



She will need to list total time of vist as well.  It can be a blurb such as I spent 50 minutes in this appt and 30 minutes spent counseling the patient on blah, blah blah...


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## cynthiar (Oct 13, 2010)

Roxanne,
Another question on this.  I have a physician who spends a lot of time counseling medicare patients on a lot of chronic illnesses.  He will use his time spent with the patient as the key component in coding the level of the office visit.  If he spends 40 minutes with an established patient, he would use the 99215 office visit, and he normally dictates he spent 40 minutes face to face with the patient.  Is that sufficent?
Cynthia


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## FTessaBartels (Oct 19, 2010)

*Time-based coding*

There are numerous threads / responses on this question. I'll recap once again.

In order to code an E/M based on time spent in counseling/coordination of care your documentation *MUST include ALL *of the following:
1. Total time spent face-to-face with patient
2. Amount of time spent in counseling/coordination of care (must be MORE than 50% of total time)
3. Nature of the counseling/coordination of care. 

If you are missing any of the above components you *cannot* code based on time.

Example of notation that does *NOT* qualify:  "I spent 40 minutes with patient today"

Example of documentation that *DOES* qualify: "I spent a total of 40 minutes with Mrs Patient today. 25 minutes of this was spent in counseling her about the progression of her disease and various treatment options and expected outcomes."

F Tessa Bartels, CPC, CEMC


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