In my coding clinic series, I previously explained all the complicated rules necessary to pass an audit by the chart police. You can find how to pass an audit for a 99231, 99232, and 99233. Did you know that you can bill these codes based on time alone? One astute reader asked if it was possible to bill these hospital follow up codes based on time only. The answer is yes and no. You can use time, but you must also document other strict rules. Before I explain the rules read this:
Nothing I say here means Jack. I am not a licensed coding compliance officer. Even if I was, what I say doesn't matter since I'm not the one paying your bills. The Medicare National Bank owns your paycheck, so you have to do what they say. It doesn't matter if I'm right or not. My interpretations are based on my understanding of the Evaluation and Management Guidelines of 1995 and 1997. As of November 2005, until further notice, carriers have been directed to use these guidelines in their reviews.
So here goes: In order to bill hospital follow up codes based on time you must document all three of the following circumstances:
- Does the documentation reveal the total time? (Face-to-face in outpatient setting or floor time in inpatient setting)
- Does the documentation describe the content of counseling and or coordinating care?
- Does documentation reveal that more than half of the time was spent counseling or coordinating care?
If you answer yes to all three of these questions, you don't have to document jack about vital signs and review of systems and HPI and physical exam and adding up points and looking up charts and risk tables. You don't have to do any of that. You just need to document these three facts. Sounds great right? Right? Do you remember the time factor the AMA thinks that each level of care should take? 15 minutes for a 99231, 25 minutes for a 99232, 35 minutes for a 99233. As I understand the rules, those are your parameters for choosing your level of CPT® medical coding based on time. And because time is so devalued in E&M coding, due to the RVU/RUC/SGR disaster, every clinic in America would go bankrupt if they only billed E&M codes based on these time parameters.
It's a rare day that I would ever use this "out" for the complex rules, because rarely do I spend 1/2 the time counseling. But if do, and time slips away from me and I find myself in a family meeting for 30 minutes, or explaining to a drug addict with dependent personality traits why they aren't going to get any more morphine from me, you can be dang sure I'm using this as an out and telling my calculator to take a hike.
For threshold times for all hospital admission (CPT® 99221, 99222, 99223), consult (CPT® 99253, 99254, 99255) and followup visits (the time the AMA expects each visit to take) go read about it at my prolonged service codes clinic. You can see much more in my free lectures on medical billing and coding.
For threshold times for all hospital admission (CPT® 99221, 99222, 99223), consult (CPT® 99253, 99254, 99255) and followup visits (the time the AMA expects each visit to take) go read about it at my prolonged service codes clinic. You can see much more in my free lectures on medical billing and coding.
LINK TO E/M POCKET REFERENCE CARD POST
|
Successful software implementation starts with choosing the right system. This checklist contains over 50 of the most important features to look for when evaluating:
- electronic medical records
- medical billing software
- scheduling software
- technology, security and certifications
Other useful information is available at my EHR Resource Center. 
Good Job! :)
ReplyDeleteHappy,
ReplyDeleteYour blog rocks. I've learned a lot from you. I'm only approaching my second year as a hospitalist attending and in our "group", which is actually owned by one of the national hospitalist company, we over utilize the code 232. Previous to the newer guidelines for follow up codes which were implemented January 2010, our group actually hit our RVU bonuses quarterly. With the new guidelines, almost have of our follow ups are 232. What gives? were we taught the wrong thing that once someone is stable and you're not doing a whole lot, 232 is the code you use despite the patient having many concurrent problems and co-morbidities? Can you shed some light on proper usage and rules of the follow up codes? Thanks.