Wiki Question on E/M 2021 changes

[ndickerson2609]

I have started with a new Gastroenterology office and sometimes we have patient's that walk in with a concern to discuss with MA's. During this time, the MA discusses the patient's concern with the Provider. The MA will then discuss how the Provider wants to proceed with the patient. Is there any way to code for the MA and Provider taking time to review patient's chart, or does the Provider need to be face to face with the patient in order to code for "counseling" a patient?

 

[csperoni]

There are some non face to face services that may be billed, but I have to say this particular situation seems a little concerning to me as the provider and patient are not speaking directly to each other. As a practice manager, I would have a lot of hesitation for this scenario since it is literally a game of telephone. Too many chances to leave out a sentence, incorrectly hear a word, misinterpret a meaning. What if the patient has an additional question? The MA is not qualified to provide medical advice.
Perhaps a better solution might be to schedule a telehealth (audio/video) or telephone (audio only) for the patient and provider to directly communicate. The telehealth and telephone services are still being covered.

 

[jkyles]

I have started with a new Gastroenterology office and sometimes we have patient's that walk in with a concern to discuss with MA's. During this time, the MA discusses the patient's concern with the Provider. The MA will then discuss how the Provider wants to proceed with the patient. Is there any way to code for the MA and Provider taking time to review patient's chart, or does the Provider need to be face to face with the patient in order to code for "counseling" a patient?

Hi there, you can only used time-based coding if the physician/QHP actually sees the patient. From the guidelines

When time is used for reporting E/M services codes, the time defined in the service descriptors is used for selecting the appropriate level of services. The E/M services for which these guidelines apply require a face-to-face encounter with the physician or other qualified health care professional. For office or other outpatient services, if the physician’s or other qualified health care professional’s time is spent in the supervision of clinical staff who perform the face-to-face services of the encounter, use 99211

Also review the activities that count toward time.

 

[ndickerson2609]

There are some non face to face services that may be billed, but I have to say this particular situation seems a little concerning to me as the provider and patient are not speaking directly to each other. As a practice manager, I would have a lot of hesitation for this scenario since it is literally a game of telephone. Too many chances to leave out a sentence, incorrectly hear a word, misinterpret a meaning. What if the patient has an additional question? The MA is not qualified to provide medical advice.
Perhaps a better solution might be to schedule a telehealth (audio/video) or telephone (audio only) for the patient and provider to directly communicate. The telehealth and telephone services are still being covered.

I agree, thank you for your thoughts.

 

[ndickerson2609]

Hi there, you can only used time-based coding if the physician/QHP actually sees the patient. From the guidelines


Also review the activities that count toward time.

Thank you!