RE: Time based Auditing

Bramey@vmchealth.com

When auditing charts on counseling/coordination of care, is it 50% or more than 50% because we are receiving differing opinions. Which is correct? At least 50% or more than 50%.

Our understanding was that time should dominate (more than 50%).

Any help would be greatly appreciated and resources where found.
Brenda


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tricia.erne@midhosp.org

CPT states, “When counseling and/or coordination of care dominates (more
than 50%) the physician/patient and/or family encounter (face-to-face time
in the office or other outpatient setting or floor/unit time in the
hospital or nursing facility), then time may be considered the key or
controlling factor to qualify for a particular level of E/M services.” This
means that time alone can be used to select a level of care, regardless of
the extent of the history, exam or the medical decision making, if the
majority of the encounter involves counseling or coordination of care. For
E/M services, counseling may include a discussion of test results,
diagnostic or treatment recommendations, prognosis, risks and benefits of
management options, instructions, education, compliance or risk-factor
reduction.

mary.flanery@medstar.net

MORE than 50%. If RIGHT AT 50%, you can’t bill based on time.


Mary Flanery, CPC, CBCS, CHC
Quality Review Specialist
Baltimore, Maryland 21220

jenocon@comcast.net

It should be greater than 50% of time. You can find this in the E/M guidelines in the CPT book, and the E/M guidelines by CMS.
Jen Vasquez, CPC, CEMC

Karyn.Cardenas-Foray@sharp.com

Agree must dominate the typical time

Karyn Cardenas-Foray, CPC, CPMA ,CHCA, CEMC,CIMC,CSEMC
AHIMA ICD10 PROFICIENT
Government Reimbursement Analyst-Sharp Health Care
PFS-CCD 3rd Floor
858-499-4382