Wiki EM by time

[adudms]

When coding by time, is the 50% rule for the entire time a patient is in the office, or just when having direct contact with medical personnel? Example - we do minor outpatient surgery. Every patient goes through a counsel session to discuss the surgery, review medical records, consent questions, concerns etc and make the final decision to proceed (these sessions last anywhere from 30 min to an hour or more) then meets the doctor for another session (about fifteen minutes), then has a final session at the end to discuss care, follow up, counselling etc (at least 30 minutes, sometimes more). The total time a patient is here can rum anywhere from 2-4 hrs, but a lot of that is waiting to go from step to step. If I code by time,I always come up with a higher code level than if I bill by 1995 guidelines. I want to justify the level of coding that accounts for all the time our doctor, nurses and counselors spend face to face with our patients but I also don't want to get in trouble if an audit is done.

 

[mhstrauss]

When coding by time, is the 50% rule for the entire time a patient is in the office, or just when having direct contact with medical personnel? Example - we do minor outpatient surgery. Every patient goes through a counsel session to discuss the surgery, review medical records, consent questions, concerns etc and make the final decision to proceed (these sessions last anywhere from 30 min to an hour or more) then meets the doctor for another session (about fifteen minutes), then has a final session at the end to discuss care, follow up, counselling etc (at least 30 minutes, sometimes more). The total time a patient is here can rum anywhere from 2-4 hrs, but a lot of that is waiting to go from step to step. If I code by time,I always come up with a higher code level than if I bill by 1995 guidelines. I want to justify the level of coding that accounts for all the time our doctor, nurses and counselors spend face to face with our patients but I also don't want to get in trouble if an audit is done.

The time component is for the physician's time only.

 

[OhioMB]

Time in the office is provider to patient face-to-face time ONLY.

The rules are different in the hospital as it is time spent on that patient in the entire day, not just face-to-face time, which would include time spent coordinating care, reviewing records, etc.