Wiki Provider Coding by Time

[jenflip]

One of our providers, a general surgeon, is selecting all his E/M levels for his office visits based on time. He is meeting the documentation criteria for reporting time-based visits when more than 50% of the visit is counseling/coordination of care. My concern is that it is EVERY VISIT.

I've crossed-checked his times with the appointment schedule as well and I don't see any concerns there.

I see this as a risk area since the AMA and CMS consider history, exam, and MDM to be key. However, I'm having trouble finding anything that states you can't ALWAYS use time to bill for office visits if appropriate. Even our MAC, WPS, says if the criteria are met the provider should do what is most advantageous.

Before I meet with provider I would like to have more leverage than just the fact that I don't think it's a good idea.

Does anyone have any advice?

 

[SienTC1720]

I agree with you that it does seem risky to always bill that way. I would think that as long as YOU as the coder feel you can show the correct amount of documentation to prove more than 50% of the time was spent counseling, etc. then you should have no problem.