How To Bill Hospital Follow Up Codes Based On Time.

In my coding clinic series, I previously explained all the complicated rules of hospital follow up coding Hospital follow up codes include CPT® 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 the following.

I am not a licensed coding compliance officer.  My interpretations are based on my understanding of the CMS Evaluation and Management Guidelines of 1995 and 1997, the CMS E/M reference guide and my understanding of the Marshfield clinic audit tool.  You can read about these resources at my
reference center.     Read at your own risk.  The definitive authority on CPT® is the AMA .   Reference the AMA authority for definitive information with the CPT 2018 Standard Edition on Amazon.  In order to bill hospital follow up codes based on time you must document all three of the following circumstances: 
  1. Does the documentation reveal the total time? (Face-to-face in outpatient setting or floor time in inpatient setting)
  2. Does the documentation describe the content of counseling and or coordinating care?
  3. 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 use the complex Marshfield clinic audit tool rules  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.  The AMA defines the time as  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 appropriate CPT® code based on time.

It's a rare day that I would ever use this "out" for the complex rules because rarely do I spend half  the time counseling.  But if I do, time thresholds tables exist for most E/M codes, including all hospital admission codes, consult codes  and followup codes.   


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2 Outbursts:

  1. Happy,
    Your 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.


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