# billing based on time - inpatient hospital



## Colliemom (Jan 9, 2009)

So I am hoping for some opinions....

1)A physician sees a patient in the hospital for a subsequent visit.  The pt has Down's Syndrome, so 30 minutes is spent in discussing the patient's dx and treatment options with the pt's family.  Can you bill based on time?

2)The patient has Medicare.  I realize that time spent in counseling with the family must be done with the patient present, when billing office charges based on time.  Must the patient be present if this is done in an inpatient hospital setting?  (As I know the physician can include floor time when billing based on time for inpatient visits in the hospital setting.)

thanks


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## FTessaBartels (Jan 9, 2009)

*Yes, you can use time in an inpatient setting*

Yes, you can use time spent in counseling/coordination of care in the inpatient setting to determine level of service. 

The note must state:
1.Total amount of time spent face-to-face with patient (floor/unit time counts for inpatient)
2. Amount of time spent in counseling/coordination of care (must be at more than half the total time)
3. Nature of the counseling/coordination of care.

So, *for example,* you might have documentation such as:  I spent 30 minutes with patient and his parents, 18 minutes of which was in counseling/coordination of care, discussing diagnosis, treatment options, risk and benefits. 

NOTE: 30 minutes in an inpatient setting equals a 99232 subsequent hospital visit. If the patient is sufficiently ill, the physician may have already documented a 99233 visit level. For a subsequent visit you only need to meet the standard on two of the three: history, exam, MDM.

F Tessa Bartels, CPC, CEMC


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