RE: Time based Auditing

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.

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  • 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

  • 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

  • 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

  • Agree must dominate the typical time

    Karyn Cardenas-Foray, CPC, CPMA ,CHCA, CEMC,CIMC,CSEMC
    Government Reimbursement Analyst-Sharp Health Care
    PFS-CCD 3rd Floor

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