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Pulmonology Coding Alert

Reader Question:

Extensive Counseling

Published on Sat Dec 01, 2001

Question: An office visit involved 30 minutes of extensive counseling (addressing emotional and social issues, and environmental control of allergens) for an established Medicare patient with asthma. How should I code this?

Virginia Subscriber

Answer: If counseling/coordination of care dominates more than 50 percent of the visit, the level of service is based on time. Documentation of the three key components (history, exam and medical decision-making) is not required for selecting the level.
 
The physician must be sure to document the amount of time spent counseling, the total visit time as well as the issues discussed. The counseling time and total visit time include the time the physician spends with the patient face-to-face. Counseling by other staff or the time the patient spends with other staff members (RN, LPN, MA, etc.) does not count toward the time for which the physician can bill.
 
Select the visit level that corresponds to the physician's total visit time, e.g., 40 minutes total visit time for which 20 minutes (50 percent) was spent counseling an established patient, 99215 (office or other outpatient visit).  
 
Another example is a patient diagnosed with asthma. The physician spends 20 minutes counseling the patient. He or she originally spent 10 minutes obtaining an interval history and performing the exam. The nurse practitioner then spends 15 minutes reviewing the patient's medication regime. The total amount of time the physician can bill for is 30 minutes, 99214 (office or other outpatient visit).
 
Questions answered by Carol Pohlig, RN, CPC, a reimbursement analyst for the office of clinical documentation at the University of Pennsylvania in Philadelphia; and Mary Mulholland, RN, CPC, reimbursement analyst with the Hospital of the University of Pennsylvania.

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