Wiki E&M Time ?

[htidd]

When coding E&M visits how do you know when to code by just the time the provider documented instead of by the HPI, Exam, & MDM? I've never coded by just time before so I'm a little curious as to when the situation applies. Is it just when the documentation doesn't include all the elements but time is documented or should I always include coding by time when I'm picking an E&M level?

 

[agibb1022]

When coding E&M visits how do you know when to code by just the time the provider documented instead of by the HPI, Exam, & MDM? I've never coded by just time before so I'm a little curious as to when the situation applies. Is it just when the documentation doesn't include all the elements but time is documented or should I always include coding by time when I'm picking an E&M level?

I have always heard that you can code by time if more than 50% of the face-to-face time was spent on counseling and coordination of care. If all 3 of these things can be answered yes, then you can code by time:
1. Does documentation reveal total time?
2. Does documentation describe the content of counseling or coordinating care?
3. Does documentation reveal that more than half of the time was counseling or coordinating care?

Hope that helps!

 

[nnewton224]

The time documented must state more than 50% was spend on coordination of care. Also make sure you figure out the elements because if the elements you get come to a higher level then what the time based statement gives you then you would go with the elements.

Hope this helps

 

[jdibble]

When coding E&M visits how do you know when to code by just the time the provider documented instead of by the HPI, Exam, & MDM? I've never coded by just time before so I'm a little curious as to when the situation applies. Is it just when the documentation doesn't include all the elements but time is documented or should I always include coding by time when I'm picking an E&M level?

Coding by time would be the exception to the rule - you would not want to use time every time you pick an E/M level! This could throw up a red flag for an audit if your doctor bills based on time for more hours in a day than he could possibly have seen patients! Also, you would not pick an E/M code based on time unless your provider's documentation supports coding by time. For example, your doctor would need to document in the note that he "spent a total of _____ minutes with the patient and more than 50% of that time was spent in counseling and/or coordination of care" and then he would need to document a synopsis of the counseling discussion and/or what was done for coordination of care. If this is the case, then you could pick the E/M code associated with the total time of the visit.

The use of time is usually used for those instances when the doctor spent a long time with the patient talking more than performing all of the elements for the HPI, Exam or MDM. We would use time, for example, for our Plastic Surgeon when she was evaluating patient's for breast reconstruction for breast cancer as she would spend over an hour going over their options, but not necessarily do all of the elements for a high level E/M. Or we would use time for our OB/GYN when they were counseling a patient beginning birth control because they spent more time with the patient and did a very minimum HPI and exam.

Hope this helps!

 

[beulastella]

E&M Time VS Key Components

Hi,

You can consider Both the time and key component for a chart but need to bill the higher level from the both and it will be the only level as we bill only 1 level for 1 encounter. for example if the time documentation as 80 minutes for a consultations chart which specifies 50% of the total time spent in counselling and co-ordination or face to face. then bill 99245 based on time, Now we don't want to check with the key components as this gives us the Highest level, incase if we find the level as level 2 or 3 by the time then check on with the Key components as it may have the chance to give us the higher level as level 4 or 5 or the same.

Thanks