Wiki Time based E&M coding

[heatherweinmaster@gmail.com]

I currently work for an Orthopedic practice that is in the process of a large merger. The incoming physicians code based solely on time. It is my understanding that Time is a factor in the E&M decision making, but sufficient documentation should be included in this process. For example, if little to no HPI, ROS or Physical Exam is documented, but the physician would like to bill a 99214 because "greater than 25 minutes was spent with the patient face to face in coordination of their care" on an established patient, I would downcode that due to lack of documentation. Does anyone have any evidence I can use to support this if I am correct?

 

[CodingKing]

Even if what care coordination was listed the statement of 25 min is still insufficient. I'd show them the 1995/97 E&M DGs. Not only should the activities be documented the total appointment time is also needed to be documented.

The guidelines can be downloaded here:

https://www.cms.gov/outreach-and-education/medicare-learning-network-MLN/MLNedwebguide/emdoc.html

DOCUMENTATION OF AN ENCOUNTER DOMINATED BY
COUNSELING OR COORDINATION OF CARE
In the case where counseling and/or coordination of care dominates (more than
50%) of the physician/patient and/or family encounter (face-to-face time in the
office or other or outpatient setting, floor/unit time in the hospital or nursing
facility), time is considered the key or controlling factor to qualify for a particular
level of E/M services.

DG: If the physician elects to report the level of service based on
counseling and/or coordination of care, the total length of time of
the encounter (face-to-face or floor time, as appropriate) should be
documented and the record should describe the counseling and/or
activities to coordinate care

 

[mhstrauss]

Even if what care coordination was listed the statement of 25 min is still insufficient. I'd show them the 1995/97 E&M DGs. Not only should the activities be documented the total appointment time is also needed to be documented.

The guidelines can be downloaded here:

https://www.cms.gov/outreach-and-education/medicare-learning-network-MLN/MLNedwebguide/emdoc.html

I agree with CodingKing. Here's more info with examples of the kinds of things that need to be included in the documentation to support the counseling/coordination of care:

http://www.acphospitalist.org/archives/2012/10/coding.htm

HTH!