Wiki counseling and/or coordination of care over phone with family member

[nikki_coder]

Can you bill an E/M service based on time (coordination of care) when the conversation is with a family member acting as decision maker for the patient but its over the phone instead of face to face? I cannot find anything helpful on CMS's website. Thanks.

 

[CodingKing]

Time based is based on face to face time. Look in the E&M Documentation guidelines document.

For example from 1995 Documentation Guidelines:

https://www.cms.gov/Outreach-and-Ed...N/MLNEdWebGuide/Downloads/95Docguidelines.pdf

D. DOCUMENTATION OF AN ENCOUNTER DOMINATED BY COUNSELING OR COORDINATION OF CARE

In the case where counseling and/or coordination of care dominates (more than 50%) of the physician/patient and/or family encounter (face-to-face time in the office or other outpatient setting or floor/unit time in the hospital or nursing facility), time is considered the key or controlling factor to qualify for a particular level of E/M services.

DG: If the physician elects to report the level of service based on counseling and/or coordination of care, the total length of time of the encounter (face-to-face or floor time, as appropriate) should be documented and the record should describe the counseling and/or activities to coordinate care.

 

[nikki_coder]

thanks for your reply. Does it have to be face-to-face in an inpatient setting though? CPT says - with patient and/or family face-to-face in the office or outpatient setting or floor/unit time in the hospital or nursing facility.