Sunday, March 30, 2014

Quick Tips for time based billing for Ob Hospitalists

Sorry I've been so long in posting... but have been zooooomingly busy. Thanks for all who have been keeping me out of mischief, and into the coding mode! .. Here's some quick tips on time-based billing that I just put out for OB hospitalists! ********************************************************************************* In an OB hospitalist practice, the usage of time based billing can be the way to go, when you have spent the majority of your time counseling your patient. In situations where this counseling and coordination of care is more than 50% of the time spent with the patient. (face to face time), usage of the “time default” may be more reflective of your care than a traditional evaluation and management code.

 When choosing to bill based upon time, CPT states that more than 50% of your visit must be spent in counseling and/or coordination of care. In addition, it requires the time to be face to face with the patient, however, it includes obtaining the pt’s HPI, chief complaint and pertinent history, the exam (if performed) and counseling that is pertinent to the problem or issue at hand.

CPT defines counseling as:
 Results of diagnostic testing
 Prognosis  Management options (eg risks, benefits, outcomes) 
 Treatment of management instructions
 Compliance with chosen management options
 Risk factor reduction
 Patient and family education

Non face to face time cannot be included as a part of your “counseling” with the patient. Non face to face time includes activities such as
 Reviewing previous records
 Reviewing previous tests
 Communicating with other professionals/written reports
 Telephone conversations with other professionals

When reporting the level of service based on counseling and/or coordination of care, the total length of time of the encounter (face to face time) MUST BE DOCUMENTED!

 In addition, the documentation must also describe the extent and the reason for the counseling and/or activities to coordinate the care of the patient. The up-side to coding by time, is that there are no specific documentation requirements for history, exam and medical decision making. However, it is recommended that you record the pertinent information about the care clearly and concisely within the record. It is absolutely essential to record the time spent, and that it is 50% OR MORE OF THE ENTIRE VISIT TIME

 Example #1: “I spent 20 minutes of 30 minutes face to face in the L&D outpatient area discussing patients’ abnormal glucose test results and increasing blood pressure, and headache. In addition, I counseled the patient in appropriate dietary changes to be made at this early stage in pregnancy and the risk factors associated with gestational diabetes and elevated BP’s.”

 Example #2 “Total visit time with patient was 25 minutes. I spent over 50% of this time counseling the patient and spouse regarding the abnormal bleeding, ultrasound confirmation of incomplete spontaneous abortion and proposed clinical management. Patient and spouse will discuss and let me know how they wish to proceed.”

 If you are a OB hospitalist that is working in a designated OB/ED area of the hospital, usage of Emergency room codes do not allow for using “time” as an option in this place of service. When using Emergency Department E&M codes, CPT requires all three standard components of History, Exam, and Medical Decision Making to be documented and met. The bottom line for all clinical documentation is.. If it wasn’t documented it wasn’t done!

Time Threshold Chart: New Patients:
(Office POS 11, Outpatient area POS 22)
99201 10 Minutes
99202 20 Minutes
99203 30 Minutes
99204 45 Minutes
99205 60 Minutes

Established Patient: (Office POS 11 , Outpatient Area POS 22)
99212 10 Minutes
99213 15 Minutes
99214 25 Minutes
99215 40 Minutes

Hospital Observation (Admit POS 22)
99218 30 Minutes
99219 50 Minutes
99220 70 Minutes

Hospital Observation (Subseq)
 99224 15 Minutes
99225  25 Minutes
99226  35 Minutes

Hospital Inpatient (Admission POS 21)
99221 30 Minutes
99222 50 Minutes
99223 70 Minutes

Hospital Subsequent (Daily)
99231 15 Minutes
99232 25 Minutes
99233 35 Minutes

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