Cardiology Coding Alert

Tracking patient counseling and coordination-of-care time during an office visit can boost E/M levels and generate more reimbursement for cardiology practices. Because cardiologists often treat chronic conditions such as coronary atherosclerosis (414.0x), they frequently take on the role of the patient's primary-care physician (PCP). Consequently, they often provide counseling and coordination of care. According to CPT, when counseling and/or coordination of care takes up more than 50 percent of the cardiologist's face-to-face time with the patient, time becomes the determining factor when choosing a particular E/M service level. The content of the counseling and/or coordination of care what the physician talked about with the patient must be documented in the medical record, CPT states. The AMA defines counseling as a "discussion with a patient and/or family concerning one or more of the following areas:
Diagnostic results, impressions, and/or recommended diagnostic studies Prognosis Risks and benefits of management (treatment) options Instructions for management (treatment) and/or follow-up Importance of compliance with chosen management (treatment) options Risk factor reduction Patient and family education." Counseling time also includes time spent with the parties who have assumed responsibility for the patient's care or decision-making. But remember, Medicare and most insurance companies do not pay for family education without the patient present. If, for example, a family member wants to talk to a cardiologist concerning a patient's chronic systolic heart failure (428.22), Medicare requires the patient to be present in the room with the family member. Tips for Measuring Documentation "The physician should document the total visit time and how much of that time was spent counseling/coordinating care," says Carol Pohlig, BSN, RN, CPC, reimbursement analyst for the department of medicine at the University of Pennsylvania in Philadelphia. "The physician should also comment on the important issues discussed with the patient in addition to any relevant clinical information, such as the patient's response."

You should remember that only the physician's time spent counseling the patient can be counted toward counseling/coordination of care time. Time spent by the cardiologist's staff on the patient's case is not reportable. Mary Falbo, MBA, CPC, president of Millennium Healthcare Consulting Inc. of Lansdale, Pa., recommends the following test for compliant documentation when billing based on time:

1. Does the documentation reveal the total face-to-face time in the outpatient setting or on the unit/floor in the inpatient setting? 2. Does the documentation describe the content of the counseling or coordination of care? 3. Does the documentation reveal that the physician spent more than half of the time counseling or coordinating care? If all of the answers are "Yes," you should specify total encounter time (in minutes), but be aware that some insurance carriers ask for specific documentation that shows the time [...]