Can consults be billed based on time?

by 
November 19th, 2015

By: Codapedia Editor (Thu, Mar/12/2009) 

Yes, both inpatient and outpatient consults may be coded based on time, when the conditions for using time are met.

CPT® tells us that a physician or NPP may use time to select a code when counseling "dominates" the visit.  CMS confirms these rules in their Documentation Guidelines. This is what they say in the 1995 Guidelines (and the 1997 ones, as well.)

D. DOCUMENTATION OF AN ENCOUNTER DOMINATED BY COUNSELING OR 
COORDINATION OF CARE 
In the case where counseling and/or coordination of care dominates (more than 50%) of 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), time is considered the key or controlling factor to 
qualify for a particular level of E/M services. 

!DG: If the physician elects to report the level of service based on counseling 
and/or coordination of care, the total length of time of the encounter (face-to-face or 
floor time, as appropriate) should be documented and the record should describe 
the counseling and/or activities to coordinate care.

What does the clinician need to document?

For outpatient consults, it is the total, face-to-face time with the patient that is counted. For inpatient consults, the unit time is the time used to select the code.  Select the code based on the total time, not the counseling time.

References:

Can consults be billed based on time?. (2015, November 19). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/can-consults-be-billed-based-on-time-27883.html

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