Counseling Must Dominate Exception Claims For Seamless Payment

Choose the service level using the documented history, exam, and MDM. Question: A new patient with a chronic gastric ulcer meets the gastroenterologist for management of her condition. The gastroenterologist meets for 34 minutes with the patient, and performs an expanded problem focused history and exam and straightforward medical decision making. The note also indicate that [...] Related articles:
  1. E/M Challenge: Can I Report 99214 and +99354?Counseling representing more than 50 percent of E/M visit? Choose...
  2. E/M Coding: Don’t Sell Yourself Short on Problem Sports ExamsTip: Time-based E/M might be in line when managing diabetes,...
  3. How Do I Code Genetic Counseling By A PhysicianLimit 96040 to Trained Counselor Question: May we report 96040...

Choose the service level using the documented history, exam, and MDM.

Question: A new patient with a chronic gastric ulcer meets the gastroenterologist for management of her condition. The gastroenterologist meets for 34 minutes with the patient, and performs an expanded problem focused history and exam and straightforward medical decision making. The note also indicate that she spent 21 minutes advising the patient on proper diet and medication management. Is this an instance where I can code based on total encounter time?

FasterCoder Advertisement

New Jersey Subscriber

Answer: Maybe. Go back and double-check both the total encounter time and the amount of time the spent on counseling by either the physician or any NPP.

If the provider spends at least half (16 min) of the total session time counseling the patient, then report …… 99203 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: a detailed history; a detailed examination; medical decision making of low complexity … Physicians typically spend 30 minutes face-to-face with the patient and/or family) for the encounter, based on the total time the provider spent face-to-face with the patient, with 531.7 (Gastric ulcer; chronic without mention of hemorrhage or perforation) appended to represent the patient’s condition.

Don’t stop there: Whenever you invoke the counseling exception for E/Ms, be sure the patient’s medical record has good documentation of the session. For instance, a good note for your scenario might read: “Spent total of 34 minutes with patient. Talked about medication options and possible side effects for 15 minutes, and about diet and ulcer management for 6 minutes.”

Remember: If you cannot enact the counseling exception for this encounter and code based on time, you must code based on the key elements. Choose the service level using the documented level of history, examination, and medical decision making the physician provides. In your case, the visit’s key components would qualify as 99202 (… an expanded problem focused history; an expanded problem focused examination; straightforward medical decision making …).

@ Gastroenterology Coding Alert

Be a hero. Join the coding community at the Supercoder Fan Page.

Get the scoop on the value of customer service and how it leads to patient retention in the Power of Customer Service for Physicians and Staff audio conference.

Related articles:

  1. E/M Challenge: Can I Report 99214 and +99354?Counseling representing more than 50 percent of E/M visit? Choose…
  2. E/M Coding: Don’t Sell Yourself Short on Problem Sports ExamsTip: Time-based E/M might be in line when managing diabetes,…
  3. How Do I Code Genetic Counseling By A PhysicianLimit 96040 to Trained Counselor Question: May we report 96040…

CPC Exam Study Guide
CCA Exam Study Guide
CCS Exam Study Guide
CPB Exam Study Guide
CRC Exam Study Guide
Facebook
Twitter
LinkedIn
Pinterest