Otolaryngology Coding Alert

Refer to the 'reference time' for counseling and coordination of care

When reporting services that count on time as a key component, you should remember that the physician must maintain careful documentation of the actual time he spends with the patient or performing relevant services.
 
In addition, coders have to know when time may apply and how much time is enough to qualify for a given level of service. Example 1: Time-Based E/M Counts on Counseling You can code an E/M service based on time when the physician spends more than 50 percent of his face-to-face time with the patient (for outpatient services) or floor time (for inpatient services) providing counseling and/or coordinating care, says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for CRN Institute, an online coding certification training center based in Absecon, N.J. CPT guidelines stress, however, that to code by time the physician must clearly document the extent of counseling and the total time involved.

How to use the reference time: For most E/M codes, CPT lists the time the physician usually spends rendering the service. For example, for established patient code 99214 (Office or other outpatient visit for the evaluation and management of an established patient ...), CPT states, -Physicians typically spend 25 minutes face-to-face with the patient and/or family.- This is called the -reference time.-

Example: Your otolaryngologist completes an expanded problem-focused history and examination (enough for a level-three visit) on an established patient with chronic ethmoidal (473.2) and frontal sinusitis (473.1), but spends a total of 25 minutes with the patient and documents that he spent 18 of those minutes providing counseling on the surgical versus non-surgical options for treating the condition. Because more than 50 percent of the visit consists of counseling, you can use the total time to determine the level of service. In this case, you could report 99214--which pays about $35 more than 99213. Example 2: Critical Care Time Is Cumulative The physician must spend a minimum of 30 minutes administering critical care services before a visit qualifies as critical care as described by 99291, according to CPT. For critical care services lasting fewer than 30 minutes, you should choose an appropriate E/M service code, says Susan Allen, CPC, compliance coder with JSA Healthcare in St. Petersburg, Fla.

You may count toward critical care time spent -engaged in work directly related to the individual patient's care whether that time was spent at the immediate bedside or elsewhere on the floor or unit,- according to CPT [emphasis added].

For instance: Time the surgeon spends reviewing tests or discussing the patient's condition with other staff, documenting critical care services, or gathering information from family or surrogate decision-makers when the patient is unable to participate [...]