Recently a Medical Economics article http://medicaleconomics.modernmedicine.com * answered a doctor’s question: “Q: I’m getting burned a lot from not billing for extra time spent with patients. What codes are available to bill above and beyond time spent?”
“A: If the additional time that you are spending with your patients is for counseling and/or coordination of care, you can bill evaluation and management (E/M) (99201-99215) codes based on time. In order to do this, you need to document the following information: Total time of the visit, time or percent of the visit spent in counseling/coordination of care, and nature of the counseling/coordination of care. Time may be estimated, but that estimate, along with the duration of the visit, must be recorded when time is used for the selection of the level of a service that predominantly involves coordination of care or counseling. Also, be sure to include counseling/coordination of care detail specific to that patient’s plan of care. Examples include discussing changes in the patient’s medical condition, lifestyle changes, new medications and new testing.
”Another tool is prolonged service codes. In order to bill these codes, you need to provide at least one hour of face-to-face patient contact beyond the usual E/M service. The time for usual service refers to the typical/average time associated with the companion E/M service as noted in the CPT code.For example: A physician spends 25 minutes managing an established patient’s chronic conditions and an additional 30 minutes counseling the patient. Since the physician spent more than half the visit counseling, he or she can bill based on time. The total time of the visit is 55 minutes, which is only 15 minutes longer than the average time for 99215. Since the time doesn’t meet the 30-minute minimum threshold, a prolonged service code cannot be billed in addition to the 99215.
* to read the full Medical Economics article “How physicians can get paid for time spent with patients” by Renee Dowling, highlight and click on open hyperlink http://medicaleconomics.modernmedicine.com/medical-economics/news/how-physicians-can-get-paid-time-spent-patients?page=0,0
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Jonathan M. Metsch, Dr.P.H., is Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai; and Adjunct Professor, Baruch College ( C.U.N.Y.), Rutgers School of Public Health, and Rutgers School of Public Affairs and Administration
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