Part B Insider (Multispecialty) Coding Alert

Question: Can we bill based on time if we see two patients during the same visit? For instance, I spent 50 minutes in a room counseling a son who brought in his parents, both of whom have COPD. One of the parents also had bronchitis and the other had sinusitis. We talked for 30 minutes about appropriate use of the nebulizer pre-emptively because the son had never helped his parents administer it. We also talked about getting the parents appropriate winter gear so they wouldn’t be breathing in cold air when they walked their dog, and other issues related to their COPD. The counseling took up about 15 minutes for each patient.

Answer : You can bill for this visit based on time, but you should create two separate encounters for the parents and count only the time spent for each patient. For example, if you spent 25 minutes with each and counseled each for 15 minutes, you’d bill 99214 for each patient and write the documentation separately, including how much total time was spent, how much time was spent counseling, and what was discussed for each patient in their visit encounter.