Learn the Coding Catch That Will Increase Your Level of Service

Coding for the time component of E/M visits can help you recoup payment
Looking for a way to adequately report your endocrinologist's counseling and coordination-of-care services?

Fact: You can code an E/M service based on time when your endocrinologist spends more than 50 percent of his face-to-face time with the patient providing counseling and/or coordinating care.

Indeed, CPT 2004 specifies that when counseling and/or coordination of care comprises more than 50 percent of the physician/patient and/or family encounter (face-to-face time), "then time may be considered the key controlling factor to qualify for a particular level of E/M services."

Benefits: CPT's counseling caveat may allow you to justify a higher-level E/M code and to charge for a visit that lacks one of the required key components (history, exam and medical decision-making) if counseling dominates the visit, says Jaime Darling, CPC, with Graybill Medical Group in Escondido, Calif. Endocrinologists routinely spend time-consuming visits coordinating care for patients with a complicated endocrine disorder, such as hypoparathyroidism (252.1) or uncontrolled type I diabetes (250.x3), but they don't always document an adequate history or exam for coding purposes. Even if one component is completely missing from the visit, the CPTguidelines indicate that "you can still code for the visit based on time as long as the physician spends 50 percent or more of his time counseling the patient -- whether it's a new or established patient," Darling says.
The key: The most important part of coding by time is having complete and adequate documentation of the visit, says Donna Rachunas of Health Claim Services Inc. in Haddonfield, N.J. When coding for the time component, make sure to do the following:
1. Make sure the chart documents the beginning and end time of the overall face-to-face visit, as well as the beginning and end time of the endocrinologist's counseling/coordination of care, Rachunas says.
2. Calculate the total visit minutes and the total counseling minutes to prove that the physician spent more than 50 percent of the visit in counseling. Example: Your endocrinologist spends 18 minutes out of a 30-minute face-to-face visit counseling the patient and determining a plan of care. Even if your physician only documents a problem-focused history and exam (both components of a level-one E/M), you can bill 99203 (New patient office visit) based on the 30-minute allotment listed for that E/M code.
3. Look for physician documentation of exactly what she discussed during the period of counseling/coordination of care. You'll need this to substantiate the time that the physician spent counseling/coordinating care, or to appeal a denial and back up the claim in case of an audit.
4. Inform your endocrinologists that detailed notes on counseling [...]

- Published on 2004-07-21