Pediatric Coding Alert

When coding based on time, you can't click off all minutes the same. Here are some of the finer points that will ensure your time-based coding is on track.

Key: You can use time to decide your code only when you spend more than 50 percent of the encounter on counseling and/or coordinating care.

You might not be giving yourself all the credit you're due if you treat inpatient time the same as outpatient time. "Inpatient time is more liberal than outpatient time," says Richard H. Tuck, MD, FAAP, a pediatrician at PrimeCare of Southeastern Ohio.

Outpatient time is face-to-face time. You can only count time the pediatrician spends directly with the patient and/or family.

Contrast: Inpatient time is floor time. When tallying hospital time, Tuck says, you can include these services:

• looking at records
• talking to nurses
• documenting the visit
• writing orders in the chart
• making related telephone calls.
  

When an encounter involves counseling, you may be tuned into using time as the key element. But you should also listen to inner urges that may alert you to times you should be coding by the clock.

Real-world tip: As pediatricians, when you see a patient and think "I'm never going to get paid for all this time," you should consider coding based on time -- and possibly using codes for prolonged services, Tuck says. "This is what we refer to as the feel of coding."

You should code based on time only when the method works to your advantage. CPT assigns typical times to many E/M codes, says Joel Bradley Jr., MD, a practicing pediatrician with Premier Medical Group in Clarksville, Tenn. When you exceed the total typical time and spend over half of that total time counseling or coordinating care, you can use time as the sole element in selecting the code level -- "provided it allows a more correct (usually higher) level of care."

Don't forget to document the:

• visit's content
• visit's total time
• time spent counseling and coordinating care.

Easy ways to document time visits include:

• Statements such as "I spent [counseling/coordination of care] minutes of [total] minutes on this service for [topic] visit."
• Shorthand abbreviations to represent total counseling/ coordination of care time and total time such as TC/TT: Time Counseling or Coordinating care/Total time.