# Time base for 99213



## NIEVESM (Aug 5, 2010)

Hello everyone,
If Dr. performed an office visit 99213 due to patient chronic pain, and noted on record spend 30 minutes counseling, in order to bill as time base do Dr. need to mentioned I spend 15 on patient exam, and 30 minutes couseling pain management, procedures etc.? please help thanks


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## cmcgarry (Aug 5, 2010)

In order to bill based on time, the following must all be present:
a)Total time of visit (end and start times are great)
b)Statement that greater than 50% of time was spent counseling/coordinating care and
c)Content of the counseling must be documented.

Just a statement that X number of minutes was spent counseling is not sufficient.

Hope this helps!


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## NIEVESM (Aug 6, 2010)

Thanks Cindy love you reply nice and simple. Thanks a lot!


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## cynthiar (Oct 13, 2010)

Cindy,
My question to you is that if a physician sees a Medicare patient, and spends 40 minutes face to face with the patient going over all their chronic illnesses, and this patient is established, can he not use time as the key component in his level of office visit?  And if so from your previous post, he must tell the complete time of the office visit, that 40 minutes was spent face to face counseling the patient and what the counseling was for. Based on the 40 minutes this would be a level 5 99215.
Cynthia


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## RebeccaWoodward* (Oct 13, 2010)

Advise physicians that when counseling and/or coordination of care dominates (*more than 50 percent*) the face-to-face physician/patient encounter or the floor time (in the case of inpatient services), time is the key or controlling factor in selecting the level of service. In general, to bill an E/M code, the physician must complete at least 2 out of 3 criteria applicable to the type/level of service provided. However, the physician may document time spent with the patient in conjunction with the medical decision-making involved and a description of the coordination of care or counseling provided. Documentation must be in sufficient detail to support the claim.

EXAMPLE: A cancer patient has had all preliminary studies completed and a medical decision to implement chemotherapy. At an office visit the physician discusses the treatment options and subsequent lifestyle effects of treatment the patient may encounter or is experiencing. The physician need not complete a history and physical examination in order to select the level of service. The time spent in counseling/coordination of care and medical decision-making will determine the level of service billed.

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.
In the office and other outpatient setting, counseling and/or coordination of care must be provided in the presence of the patient if the time spent providing those services is used to determine the level of service reported. Face-to-face time refers to the time with the physician only. Counseling by other staff is not considered to be part of the face-to-face physician/patient encounter time. Therefore, the time spent by the other staff is not considered in selecting the appropriate level of service. The code used depends upon the physician service provided.

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

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