office coding based on time

Since I have a mostly geriatric population, I schedule face to face time with each patient and the physician for 25 minutes, and we always use that aloted time - even if we review 1 condition or 10 or a new problem.

Can I always bill a 99214 based on time if time was 25 minutes? Meaning, right now, I spend a lot of time documenting to meet level 4 e/m coding. If yould make it a lot easier for me in terms of documentation, so less time write in HPI, ROS, SH/FH, PE, MDM if I can ALWAYS bill based on documenting time of 25 minutes.

Regards,

re: office coding based on time

Time has nothing to do with a patient visit UNLESS greater than 50% of face to face time with physician is spent in counseling or coordination of care. You must document total face to face time with physician, what amount of that time was spent in counseling the patient and what you counseled on! Otherwise you document the H&P and MDM on medical necessity based on presenting problems. A consistent billing of code 99214 will raise red flags with payer.

re: office coding based on time

50% of face to face time is always spent counseling on there conditions, such as Diabetes, HTN, high chol, and obesity which is done with the physician. Even if there is only one condition like stable asthma, most of the time goes into counseling/educating the patient and appt still takes 25 minutes of face to face time.

So while it may raise red flag, it's the truth in terms of work done for that patient during that encounter. However instead of filling the encounter note with lengthy history, physical or MDM, why can't we write a brief note but put 25 minutes spent with face to face time of which 50% time spent on counseling on above conditions.

eg:
CC: asthma
HPI: since last encounter no flairs, no cough, compliant with medications
PE: VSS
Lung CTA

Labs- spiro normal, peak flow nl

A/P 1) asthma - chronic stable cont current Rx
25 minutes spent with pt of which 50% time spent face to face via physician on counseling about asthma, treatment, and self management.

Few words (24+time stamp), hence less time to complete note, well summarized without excessive verbiage and then bill encounter based on time with proper time tag line.

This is what we do, spent most of the time of every 25 minute visit MD visit for counseling on condition, pathophysiology, treatment and potential s/e etc.