Wiki Help with time-based coding

[cyrucats]

I have a endocrinologist who bills mostly level 4 and 5 E/M codes. All her new patients are level 5. She is very thorough and meets the code chosen on the NP encounters. My problem is with her established patients. She spends a lot of time going over diabetes logs, making insulin pump changes, and reviewing the data from the insulin pump. (they download it right into our EMR) Bullet wise she is meeting a 99213 but there is nothing that gives extra credit for her review of all this info and the medication changes that results from it. She is spending 30-45 minutes on each patient.
Would billing for time be appropriate in these encounters? I think so, but I am hesitant to tell her to bill for time on every established patient. Raising the level of service is not appropriate either.
Does anyone have any suggestions here? Thanks!

 

[jackson7591]

Medical necessity

Whether you use time based coding or strict E/M coding guidelines, medical necessity must always be met. Also, note that for out patient settings, time based coding is based on face-to-face time? 40 minutes reviewing diabetes logs and insulin pump logs separate from the pt does not "start the clock" for time based coding.

If the complexity of information in these logs affect the pt's care/tx planning (documented) the E/M level should be higher. But if not, time spent reviewing this information should not be the basis for a higher coding schedule.

 

[MnTwins29]

"reviewing"

Are these "reviews" done with the patient? The results discussed with the patient? If decisions are made to modify medications or such, are these reviewed with the patient before writing the script? If so, these would seem to satisfy the requirement for time based coding. But if these are done in a separate area before or after seeing the patient, then no, this cannot count toward the time.

 

[CrysLednum]

I would be careful with assigning time-based to all of her E/M encounters. As stated by the other posts, MDM needs to be documented. Really, all of her E/M's are Levels 4 & 5? If she is meeting the criteria (2/3) for the Established E/M visits and the MDM supports it, throwing in the time and documenting ">50% of the 25 minute visit was spent face-to-face, with counseling and coordination of care...." would be fine, but I would just confirm that all the review she is doing is with the patient.