Know how compliant, time-based E/M billing can help generate more revenue for your medical practice
You’ve done the work to help your patient. Now you need to choose the right evaluation and management (E/M) code to bill your services. In 2021, new American Medical Association (AMA) guidelines made it possible for physicians to choose an E/M code based on total time spent on the date of the encounter or medical decision making (MDM). This means when time supports a higher E/M level, you can use time for E/M code selection. Likewise, when MDM supports a higher E/M level, you can use MDM for E/M code selection.
This article provides a few pointers about time-based medical coding to ensure revenue integrity and avoid underbilling your services.
1. Know when it’s advantageous to bill E/M codes based on time.
In many cases, it may be more financially advantageous to bill based on the complexity of the MDM. For example, you may be able to bill a higher E/M level for patient with multiple chronic conditions even if you only spend a few minutes with them. Alternatively, a patient with only one chronic condition may require significant education and counseling in which case it might make more sense to bill an E/M based on time. Thinking through this medical coding decision carefully enables you to potentially increase the profitability of your medical practice.
2. Identify the time thresholds for each E/M code.
Each E/M code has a certain number of associated minutes. Consider the following time thresholds:
99202: 15-29 minutes
99203: 30-44 minutes
99204: 45-59 minutes
99205: 60-74 minutes
99212: 10-19 minutes
99213: 20-29 minutes
99214: 30-39 minutes
99215: 30-54 minutes
When billing E/M codes based on time, be sure to choose the appropriate E/M code based on the amount of time you spent with the patient. Eligible time includes the face-to-face and non-face-to-face time that the physician personally spends before, during, and after the visit on that same day. It does not include services that are separately reportable.
3. Focus on clear and specific documentation.
If you’re billing E/M levels based on time, you’ll need to document the total time you spent with the patient on the date of the encounter and what you did during that time. For example, did you counsel the patient or coordinate care? Did you counsel or educate the patient, family, or caregiver? Did you document clinical information in the electronic health record? What about independently interpreting results and communicating those results to the patient, family, or caregiver?
Here are some other tasks that count toward time-based medical billing when you perform them on the date of the encounter: Obtaining and/or reviewing a separately obtained history; ordering medications, tests, or procedures; performing a medically appropriate exam and/or evaluation; preparing to see the patient (e.g., reviewing tests); and referring and communicating with other healthcare professionals.
Do not include time spent on a calendar day other than day the patient was seen, services that are separately reportable (e.g., chronic care management and transitional care management), or clinical staff time (activities performed by medical assistants, licensed practical nurses, registered nurses.
The American Academy of Family Physicians (AAFP) provides these tips to track and maximize time:
Use the timer in your EHR if it has one. The timer will automatically track when you’re logged in to a patient’s chart. Keep the chart open while you’re reviewing records, before the visit, and during the visit as well.
Keep the patient’s chart open during phone calls.
Don’t forget to count the time you spend checking your state’s Prescription Drug Monitoring Program before prescribing controlled substances, completing Family Medical Leave Act paperwork, certain referral tasks, and more.
Keep in mind that the primary goal of documenting time is to ensure an accurate record of the total time spent on patient care on the date of the encounter.
4. Know when to report prolonged services.
You can report 99417 when you spend at least 15 minutes beyond the time range associated with E/M codes 99205 and 99215. More specifically, report E/M code 99417 for each 15-minute increment. For Medicare, report G2212 for prolonged services, but note that the time thresholds are different. This AMA guide provides more information.
5. Think through your medical coding decision.
As mentioned previously, it may be more financially advantageous to select an E/M level based on your MDM. Ask yourself these questions: Did you spend a lot of time with the patient collecting their history or performing the exam? If so, time-based medical billing may be the best option. However, if you spoke with other physicians, reviewed complex data, or ordered several tests, MDM may be the way to go.
Conclusion
Knowing when to report E/M codes based on time can be a game changer for your practice. With accurate and complete documentation, you can potentially bill higher E/M levels and generate more revenue for your medical practice. Learn how edgeMED can help and be sure to visit the Healthy Snacks Blog for more expert insights, best practices and industry trends.
