Wiki Confusion about time spent

[chriskhans]

At the end of every office note, our provider adds a statement similar to this:

"Greater than 50% of the face-to-face time was spent in counseling and discussion of diagnosis and treatment plan. Time spent with the patient was 50 minutes"
I was always under the impression that the time that in this statement is time that the Physician not the nurses, actually spent with the patient. However, I have some people challenging that stating it's the total time that was spent with the patient overall. For example the nurse spent 20 minutes performing a test on this patient and the doc spent 30 mins. Therefore they think 50 minutes should be documented.
Opinions are helpful.
Thanks

 

[AmandaBriggs]

Per the E/M Services Guidelines in CPT:
Face-to-face time (office and other outpatient visits and office consultations): For coding purposes, face-to-face time for these services is defined as only that time spent face-to-face with the patient and/or family. This includes the time spent performing such tasks as obtaining a history, examination, and counseling the patient.

Time is also spent doing work before or after the face-to-face time with the patient, performing such tasks as reviewing records and test, arranging for further services and communicating further with other professionals and the patient through written reports and telephone contact.

This non face-to-face time for office services - also called pre- and postencounter time - is not included in the time component described in the E/M codes. However, the pre-and post-non-face-to-face work associated with an encounter was included in calculating the total work of typical services in physician surveys. CPT 2015, page 8

Face-to-face time is therefore the time that the provider spends with the patient. Ancillary staff time does not count.

 

[jdibble]

At the end of every office note, our provider adds a statement similar to this:

"Greater than 50% of the face-to-face time was spent in counseling and discussion of diagnosis and treatment plan. Time spent with the patient was 50 minutes"

Time is based only on the physicians face-to-face visit with the patient in the office and other outpatient visits. In the hospital setting it includes unit/floor time, which includes time present on the patient's unit and at the bedside. This includes time spent reviewing the patient's chart, examining the patient, writing notes, and speaking with other professionals and the patient's family.

Billing based on time should be the exception to the rule. Unless your physician is performing face-to-face counseling and coordination of care for more than 50% of this patient's visit and he is documenting the true time he has spent, I would suggest that he not use this statement on each visit! If he is billing on time alone, this could send up a red flag for an audit and unless his schedule coincides with the times that he is billing he will have issues. In other words if he is trying to bill 50 minutes for each patient he sees in a day, technically he can only see 8 to 9 patients a day and if he has 20 scheduled he will have issues!

We educate our doctors to only use the statement for those visits where they trully have performed face-to-face counseling for more than 50% of the visit and for whatever reasons they were not able to meet all of the required elements. They also need to thoroughly document the content of the counseling visit.