New patient consult...

hello again all..

I have a doctor who dictated HPI and MDM for a NP consult 99243 but stated...

I did not do an exam on Mr. X today but we spent 45minutes counseling session


Does time work in this situation? Can I bill the 99243?

Time and documentation

Medicare: "When counseling and/or coordination of care dominates (more than 50%) the outpatient/office face-to-face physician/patient encounter or the inpatient floor/unit time, time is the key or controlling factor in selecting the level of E&M service." Document total face-face time, how much was spent in counseling and issues discussed:
Definition of "Counseling" : a discussion with a patient and/or family regarding-
• Diagnosis, impressions, prognosis, recommended diagnostic studies
• Risks and benefits of treatment options
• Instructions for management, treatment and/or follow-up care
• Importance of compliance with treatment, risk factor reduction
• Patient and/or family education

time and documentation

Strictly speaking, the preferred documentation would be "All of the 45 minute visit was spent..." or, "Over half of the 45 minute visit was spent..."

Also, there should be a summary of the nature of the discussion.