Part B Insider (Multispecialty) Coding Alert

Hint: When you code based on time, everyone wins.

The old saying goes “haste makes waste,” and there is no place that this is more prevalent than medicine. Packing in the patients daily and rushing through their exams to meet your financial quota is never a good idea.

This is why Lee Peter Bee, DO, DC MS, FACOI, a solo practitioner with Southern Illinois Medical Specialists in Sesser, Ill., believes coding based on time spent not only allows you to increase your cash flow, but also encourages you to provide a more thorough and educated exam. Bee has an innovative approach to practice management, instituting low-cost technology solutions while maximizing his coding to bring in approximately $3 million in revenue each year.

Here’s how: Using the Dragon medical dictation system, he’s able to dictate his notes during the exam and in front of the patient, giving more attention to detail and cutting down on errors. He uses this method because he runs a concierge-style practice rather than getting as many patients as possible through the door.

“We don’t practice on a volume basis because we are working away from fee-for-service—if all you see of patients is going in and out, you’re not really taking care of the patient—they could get that from the walk-in clinic at a grocery store,” he says.

As an internal medicine specialist, he focuses on giving the patients as much time as necessary to diagnose and treat their illnesses versus rushing to the next appointment. With his integrated systems and comprehensive on-the-go dictation, he’s able to devote this time, taking audit-proof notes and billing at the end of the visit.

Almost All E/Ms Are Time-Based

If you shy away from coding based on time, you’re probably losing money. “I personally put in all the E/M codes based on time since everything is time based,” Bee says. “The majority of the time, other doctors are billing 99213 (Office or other outpatient visit for the evaluation and management of an established patient…), but if you spend a good hour with them, you should be paid for the hour. If you have documented up to 60 minutes, I bill 99354 (Prolonged physician service in the office or other outpatient setting requiring direct [face-to-face] patient contact beyond the usual service first hour), and if it’s greater than that, I bill 99355 (Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service...each additional 30 minutes). The majority of the time, other doctors aren’t doing that.”

Documentation is the key, Bee insists, and he credits his use of Dragon software and its easy integration with his EHR program at the core of his success.

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