Wiki 99310 Time Based?

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adriennedolezal

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I am curious if it is possible to bill a 99310 based on time alone? We have a new provider that is making me really think on this as the documentation in the note does not meet the guidelines but they are pushing back stating they documented time so its ok to bill.

If you can use time to bill a 99310 what is also required in the note?

Sorry but this is new to me as we as a company do not use time for our SNF codes.
 
I found this from CGS MAC:
It appears you may use time with the caveat of > 50% spent counseling/coordination of care. Specifically:
"Practitioner’s choosing to use time as the determining factor:
- MUST document time in the patient’s medical record
- Documentation MUST support in sufficient detail the nature of the counseling
- Code selection based on total time of the face-to-face encounter (floor time), the medical record MUST be documented in sufficient detail to justify the code selection"
I could see it being very possible for 35 minutes if the provider is co-ordinating care with other physicians - cardio, pulm, ortho, etc.
 
csperoni said:
I found this from CGS MAC:
It appears you may use time with the caveat of > 50% spent counseling/coordination of care. Specifically:
"Practitioner’s choosing to use time as the determining factor:
- MUST document time in the patient’s medical record
- Documentation MUST support in sufficient detail the nature of the counseling
- Code selection based on total time of the face-to-face encounter (floor time), the medical record MUST be documented in sufficient detail to justify the code selection"
I could see it being very possible for 35 minutes if the provider is co-ordinating care with other physicians - cardio, pulm, ortho, etc.
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I have found all of this as well. Which brings my next question...can they just document time and do not have to meet the 2 out of 3 documentation requirements in their note?
 
adriennedolezal said:
I have found all of this as well. Which brings my next question...can they just document time and do not have to meet the 2 out of 3 documentation requirements in their note?
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Yes, as long as they meet all the requirements for documenting their time as Christine noted in her post above. If those requirements are not met, you should score the E/M based on the HPI/ROS/MDM that is present in the note.
 
trarut said:
Yes, as long as they meet all the requirements for documenting their time as Christine noted in her post above. If those requirements are not met, you should score the E/M based on the HPI/ROS/MDM that is present in the note.
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Thank you. The notes do not meet based on the E/M HPI/ROS/MDM and that's why I'm asking as the provider is pushing back as they said time works. As a company we have never allowed time to count for these codes so its just a new world for me and being it's a new provider I just need to have my ducks in a row.
 
I understand. Those little quackers are hard to corral sometimes :) The statement below is from the E/M Guidelines in the CPT manual, which may help you prove your point:

Time may be used to select a code level in office or other outpatient services whether or not counseling and/or coordination of care dominates the service. Time may only be used for selecting the level of the other E/M services when counseling and/or coordination of care dominates the service.
When time is used for reporting E/M services codes, the time defined in the service descriptors is used for selecting the appropriate level of services. The E/M services for which these guidelines apply require a face-to-face encounter with the physician or other qualified health care professional. For office or other outpatient services, if the physician’s or other qualified health care professional’s time is spent in the supervision of clinical staff who perform the face-to-face services of the encounter, use 99211.
 
trarut said:
I understand. Those little quackers are hard to corral sometimes :) The statement below is from the E/M Guidelines in the CPT manual, which may help you prove your point:

Time may be used to select a code level in office or other outpatient services whether or not counseling and/or coordination of care dominates the service. Time may only be used for selecting the level of the other E/M services when counseling and/or coordination of care dominates the service.
When time is used for reporting E/M services codes, the time defined in the service descriptors is used for selecting the appropriate level of services. The E/M services for which these guidelines apply require a face-to-face encounter with the physician or other qualified health care professional. For office or other outpatient services, if the physician’s or other qualified health care professional’s time is spent in the supervision of clinical staff who perform the face-to-face services of the encounter, use 99211.
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This is the statement per the provider:
Meeting with daughter, staff, pharmacy, and patient is in excess of 45 minutes to coordinate care and review plan

The ROS has 3 and Exam has 3 that's it so it would have to fall on the statement above.
 
adriennedolezal said:
This is the statement per the provider:
Meeting with daughter, staff, pharmacy, and patient is in excess of 45 minutes to coordinate care and review plan

The ROS has 3 and Exam has 3 that's it so it would have to fall on the statement above.
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To me, that doesn't look like that would be enough documentation to code by time. Doesn't the provider have to be more specific about how much time is spent doing each thing or could I be thinking of something else?
 
carlystur said:
To me, that doesn't look like that would be enough documentation to code by time. Doesn't the provider have to be more specific about how much time is spent doing each thing or could I be thinking of something else?
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That's exactly where I am at with this. I'm not sold on the documentation and don't want to start a fight with a new provider.
 
The provider doesn't have to itemize their time but should indicate what specifically s/he is coordinating care for, if it's not glaringly obvious from the rest of the note.
 
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