Otolaryngology Coding Alert

Question: If the physician does work in preparation for an office visit the day before, or continues working on a case in the days following a patient’s appointment, can I count the time spent on those activities toward total time?

New Jersey Subscriber

Answer: You can only include time from work done on the date of service (DOS) in your calculation of total time. Counting time that was expended on a day other than the DOS is an example of a time-related red flag.

If your physician has a conversation with a referring physician on the DOS, you can count that toward total time. But if they cannot reach the referring physician until two days later, the time spent talking to the referring physician cannot be included in the total time.

Likewise, if the physician reviews the patient’s history at 8 p.m. the night before the visit, the review is not taking place on the DOS, so that time may not be counted. But if the chart review takes place after midnight the night before the patient is seen, you can count that time since the work is taking place on the date that the patient is seen.

Keep in mind: 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 realistically work in a day. Providers need to be precise and able to support the total time they are submitting for every workday.