Coding based on time

July 27th, 2015 - Betsy Nicoletti

How much time does it take to see a child with asthma or to discuss behavioral problems with parents? Or, to explain the importance of diet and exercise in a child whose weight is increasing at an unusual pace? A lot. These types of visits are not simple or quick. How can a pediatrician be paid for those services and what level of service should be selected?

All physicians, physician assistants, and nurse practitioners may use time to select the level of service of an office visit or consult when these conditions are met:

* Counseling dominates the visit. That means that more than 50% of the face-to-face time is spent in counseling and discussion.
* The total time and the approximate percentage of the time spent in counseling is documented in the records.
* The nature of the counseling is described.

When these conditions are met, the normal requirements for history, exam, and medical decision-making are not in force. Rather, the total time (not the counseling time) of the visit determines the code. There are many common situations in which a pediatrician might use time rather than the three key components to select a level of service.

* A parent schedules an appointment for a child with asthma who also has a URI. The physician spends the majority of the visit discussing triggers, diet, exercise, and the appropriate medical regimen.
* An adolescent girl presents to discuss how the medicine prescribed for her depression is working. She also is being treated for GERD and the pediatrician reviews lifestyle changes.

An example of how to document this would be: "I spent 30 minutes with the patient, over half of it discussing the importance of watching her diet and not eating before going to bed." It would be insufficient to say simply, “we had a long discussion,” or, “I spent an additional 20 minutes with the patient.” The total time must be documented and the fact that more than 50% of that total was spent in the discussion.

In the office, count the face-to-face time with the patient, not the time spent out of the exam room reviewing records or talking to other health care professionals. Using time is like playing the trump card in the selection of an Evaluation and Management service. Properly documented, it removes the other documentation requirement for the key components, including history, exam, and medical decision-making.

^CODE	^{TYPICAL TIME}
^{New patient, office}
⁹⁹²⁰¹	¹⁰
⁹⁹²⁰²	²⁰
⁹⁹²⁰³	³⁰
⁹⁹²⁰⁴	⁴⁵
⁹⁹²⁰⁵	⁶⁰
^{Established pts.}
⁹⁹²¹²	¹⁰
⁹⁹²¹³	¹⁵
⁹⁹²¹⁴	²⁵
⁹⁹²¹⁵	⁴⁰
^{Outpatient Consulations}
⁹⁹²⁴¹	¹⁵
⁹⁹²⁴²	³⁰
⁹⁹²⁴³	⁴⁰
⁹⁹²⁴⁴	⁶⁰
⁹⁹²⁴⁵	⁸⁰

###

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