American College of Physicians: Internal Medicine — Doctors for Adults ®


Billing by the hour?

From the September ACP Observer, copyright 2007 by the American College of Physicians.

PMC TipsFor many physicians, it seems as though the entire reimbursement system would be easier if they could just bill like attorneys or plumbers: by the hour. In some cases, in fact, evaluation and management codes can be determined by time.

In order to select a code level based on time, the physician must spend at least 50% of the visit counseling or coordinating care for the patient. The level is based on typical times listed in the CPT books. For example, 50 minutes with 50% of the time counseling or coordinating care is considered to be a 99214. In this case, the documentation of history, exam and medical decision-making is not relevant at all to the selection of the code. The physician should still be documenting for the purposes of patient care.

In addition to this documentation, the physician should indicate in the record the total time spent with the patient and explicitly state that the time was spent on counseling or coordination of care. Because the visit would still have to be medically necessary, the physician should document a chief complaint or reason for the counseling. Remember that the length of the visit does not directly drive the code level unless that time was spent on counseling or coordination of care.

For more information about proper coding and billing techniques, members can download "Coding for Internists: The Basics."

"PMC Tips" is a regular feature on small-practice management from ACP's Practice Management Center.


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