Part B Insider - 2019 Issue 6
Guidelines: Take These 3 Tips to Get Time on Your Side
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Article Overview
This article discusses the counseling exception in evaluation and management (E/M) coding, with a focus on when time may be used as the basis for code selection and what supporting documentation payers expect. It is aimed at coders, billing staff, clinicians, and practice managers who need to understand time-based E/M documentation, audit readiness, and common clues that a visit may qualify for time-based reporting. The article references CPT and ICD-10 in a general way and emphasizes practical documentation and workflow considerations rather than specialty-specific rules.
Why This Topic Matters
Correct use of time-based E/M reporting can affect claim accuracy, audit support, and reimbursement. The article highlights documentation habits that help clinicians and coding teams support claims consistently.
Article Sections
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Tip 1: Make 50 Percent Mark Before Considering Exception
This section explains the time-based E/M concept discussed in the article and outlines the broad circumstances under which encounter time becomes relevant. It also contrasts the general idea of standard component-based coding with time-based selection.
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Tip 2: Use Live Documentation to Make Exception Claims Go
This section focuses on documentation practices that support time-based E/M claims, including how time tracking is captured in the record. It also discusses the role of real-time documentation for audit support.
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Tip 3: Look for These Phrases on Potential Exceptions
This section describes broad verbal cues and charting clues that may suggest a time-based E/M encounter. It emphasizes that the article is looking at general indicators rather than diagnosis-specific criteria.
What You Will Learn
- How the counseling exception relates to time-based E/M coding
- What documentation elements support a time-based visit
- What general phrases may signal that time-based reporting should be considered
- Why accurate time capture matters for payer review and audits
Who Should Read This
- Medical coders
- Billing staff
- Physicians and other clinicians
- Practice managers
- Coding and reimbursement consultants
Codes Discussed
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