Wiki Nursing Home E/M

[johnshawna1]

Mutliple part question:
1) why can a provider include documenting their visit note in the total time for the nursing home codes, but not the office codes?
2) if all the ICD10 info states that the providers will take longer to document with no additional reimbursement, how is that correct if the total floor/unit time including documentation can be counted in the nursing home
3)if the provider documents total time and is still being denied by Medicare for a 99310 even upon appeal, what are people doing to combat that?
4)if a NP collaborates with their supervising doc can that time be counted towards the total time for the e/m code?

 

[CatchTheWind]

1) why can a provider include documenting their visit note in the total time for the nursing home codes, but not the office codes? Because the rules for time-based billing (ie: when more than 50% of the time is spent counseling or coordinating care) are different for office visit codes than they are for facility visit codes. For office visits, the rule is that you count the time spent face-to-face with the patient and family, while the rule for facility visits is that you count the time with the patient or on the floor or unit. Since documenting notes can be considered part of floor or unit time, that's why it can be counted.
2) if all the ICD10 info states that the providers will take longer to document with no additional reimbursement, how is that correct if the total floor/unit time including documentation can be counted in the nursing home It seems like that might be the exception to the rule, since billing facility visits based on time is one of those rare cases when the time spent in documentation actually does get reimbursed.
3)if the provider documents total time and is still being denied by Medicare for a 99310 even upon appeal, what are people doing to combat that? Did he document that at least 50% of the time was spent with the patient or on the floor AND document the amount of time spent? If so, I would suggest taking it to a higher level appeal.
4)if a NP collaborates with their supervising doc can that time be counted towards the total time for the e/m code? It sounds like you are getting into the realm of "shared visits," which I have never used, so I can't give you much information about that. Maybe someone else can!

 

[johnshawna1]

Various answers to the same question

I sent my question to our CMS rep and a national consultant who both said no time spent documenting the note cannot be counted towards time for the e/m code. I even sent the wording from the CPT book that states floor/unit time = documentation time.

I was referred to pg XV of the CPT book that states that the word documentation does not always mean "documentation" and to the CMS nursing home regs.

It appears that while it is written in the CPT book to appear as thought that time can be counted, they did not mean for true progress note documenation time to count.