Wiki MDM or Time

[samelcher]

When coding an outpatient office visit can MDM trump time? Example if the provider sees the patient for 52 minutes and wants to code a level 5, but the documentation does not support a level 5. Wouldn't it make sense to down code to what the documentation supports versus billing only on time?

 

[jkyles]

When coding an outpatient office visit can MDM trump time? Example if the provider sees the patient for 52 minutes and wants to code a level 5, but the documentation does not support a level 5. Wouldn't it make sense to down code to what the documentation supports versus billing only on time?

Hi there,

You can code the visit based on time if the doctor documented the time. Under the guidelines you can decide whether to code based on time or MDM for each visit. The documentation requirements for MDM don't apply if you're coding based on time.

You do need to make sure the doctor didn't count time for work that can't count toward time, and you should remind them that in the future they can count time for non-face-to-face services on the day of the encounter, such as reviewing test results before the visit or updating the EHR after. They might not get full credit if they just count face-to-face time.

 

[lgardner]

ALSO, even when coding a visit based on time, medical necessity is the overarching criterion.

 

[jkyles]

Right, therefore face-to-face time can't include discussion that isn't related to the encounter (like a conversation about a recent football game) or general, rather than patient-specific, education.