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TWilliam2019

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Trying to get clarification on e/m coding

1) office visit
when using time for counseling and coordination of care can the NP and DR time be combined to get the total time?

2) office visit
can NP sign the note with the statement DR reviewed and agree.?
 
TWilliam2019 said:
1) office visit
when using time for counseling and coordination of care can the NP and DR time be combined to get the total time?
Click to expand...

The time used should be the total face-to-face time with the provider(s), so yes, you can add the times together as long as they are all face-to-face time and not overlapping and more than 50% of that time was in counseling/coordinating care.

TWilliam2019 said:
2) office visit
can NP sign the note with the statement DR reviewed and agree.?
Click to expand...

Yes, but it can only be billed under the MD if the visit meets all of the 'incident to' requirements. Reviewing and agreeing with the NP, in and of itself, is not sufficient for the visit to be billed under the MD.
 
Hello Thomas, I was referring to the CMS Manual - Ch 12; Section 30.6.1: Part C "Selection of Level of Evaluation and Management Service Based On Duration of Coordination of Care and/or Counseling" - Please see the following where it states: "....Face-to-face time refers to the time with the physician only. Counseling by other staff is not considered to be part of the face-to-face physician/patient encounter time. Therefore, the time spent by the other staff is not considered in selecting the appropriate level of service. The code used depends upon the physician service provided...." Please clarify if you've obtained info from a different source? Thanks.




thomas7331 said:
The time used should be the total face-to-face time with the provider(s), so yes, you can add the times together as long as they are all face-to-face time and not overlapping and more than 50% of that time was in counseling/coordinating care.



Yes, but it can only be billed under the MD if the visit meets all of the 'incident to' requirements. Reviewing and agreeing with the NP, in and of itself, is not sufficient for the visit to be billed under the MD.
Click to expand...
 
I believe that throughout the chapter of the manual you are citing - for example see parts A and B of the same section as above - CMS has made clear that qualified non-physician practitioners may bill under the physician fee schedule and the same general coding guidelines apply to them as to physicians. There are instructions throughout the manuals that say simply 'physician' but clearly are meant to apply to NPPs as well. If that were not the case, then under a strict reading of this section, only physician would be eligible to bill using time and I can't imagine CMS would intend this without saying so explicitly. Taken in context, I think that when they are referring to 'other staff' in this particular, they are not referring to employed office staff and not to other practitioners that may bill for face-to-face time I could be mistaken, but I haven't ever seen anything to indicate that this should be interpreted otherwise.
 
Thnx for your reply--yes, I did/have seen the previous sections throughout the whole manual; and am aware of the interchange of Dr vs NPP; Incident to billing, Split/shared, etc.---In regard to billing based on time and the counseling/coord of care, I read this to only be counted if performed by the physician; not 'in part by the physician'. But as we all know, coding; and it's guidelines; can be left to interp for sure if no clear/precise instruction is given. I've re-read this section, & the others, several times now and can also see what you're saying. If time allows, I mite continue to research this throughout the day & will post if I run across anything more definitive; if not, I'll just leave be. Thanks.
 
Just another quick side note; seems that if they [CMS] did mean/infer that other HCP's could perform the counsel/coord as well and this to be allowed/counted towards the total time, then they would've stated this as they have in other areas; instead of saying "only physician face-to-face" is counted and that no other staff is - then that way it would be very black and white. Just thinking out loud here....will hopefully have time later to continue researching.
 
help

65 minutes spent on the phone with Humana and preparation of paperwork for appeal process
22 minutes spent in discussion with the patient
10 minutes spent in coordination with case manager
See today's separate progress note as well

97 mins total
This is a portion of a note that clarifies the time part for coordination of care.
how would you code this?
 
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