Question: Can the time spent by the doctor preparing for a patient’s appointment a day before the appointment, or working on the case in the days after the appointment, be included in the total time calculation?
RCI Subscriber
Answer: No, only the time spent on the patient on the same day of service (DOS) can be counted toward the total time calculation. Attempting to add time spent on other days is a time-related red flag and should not be included.
If your physician has a conversation with a referring physician on the DOS, however, you can count that toward total time. But if they cannot reach the referring physician until two days later, for example, the time spent talking to the referring physician cannot be included in the total time.
In this same sense, if the doctor reviews the patient's history the night before the appointment, this time cannot be included since it’s not on the day of service (DOS). However, if the review of the patient’s records happens after midnight on the day of the appointment, this time can be included as it is considered part of the same DOS.
Remember: Physicians have been indicted and prosecuted for fraud just based on the fact that their evaluation and management (E/M) services added up to more hours than a physician could physically work in a day. It is imperative that providers are accurate and able to justify the total time they are claiming for each working day.
Lindsey Bush, BA, MA, CPC, Development Editor, AAPC
