Most healthcare practitioners rely on the ‘key components,’ namely history, exam, and medical decision-making, for all their billing purposes. But what about medical counseling or face-to-face interactions where these three key components do not come into picture? In such cases, the only viable option available to measure the level of service offered for billing is time.
Yes, time! Doesn’t a lawyer charge by the hour and why not the same apply to doctors? However, using time as a key determinant is not as simple as it sounds. You need to understand the various clauses involved to employ this method appropriately. Do bear in mind that time cannot be used as a determining factor at all times. There are certain riders that needs to be satisfied and here is quick look at them-
Time-based billing will only be applicable when the doctor uses more than 50% of the total visit time interacting with the patient, providing counseling/care to cure their ailments. In instances when the doctor spends very little time providing face-to-face care, time-based billing is not a legitimate option. For instances, let’s say you examine a chain-smoker suffering from respiratory ailments and bring up the idea of quitting smoking.
He is reluctant initially, but comes around after you take some time to show him some statistics over the Internet. And then you move on to the more critical discussion about smoking cessation, including lifestyle changes that he must employ. The entire discussion lasts for 42 minutes, while examining him took just two minutes. In this scenario you can opt for time-based coding. And say if the discussion lasted for less than half of the total visit time, i.e., less than 22 minutes, then you cannot use this type of coding.
Further, time spent by ancillary service providers, such as a nurse checking blood glucose levels or BP for time-based billing cannot be considered. The same is the case when you leave the room to attend another patient.
Time-based billing starts with documentation and hence physicians must document the entire interaction, including history and exam, discussion points and patient response. They must also record both counseling and total visit time and finally associate the corresponding CPT codes for the offered evaluation and management (E/M) service as per the CPT manual.
This procedure works fine for general E/M services but what about prolonged services that lasts for more than one hour. How to bill for these prolonged services?
Here are steps that you need to follow-
Firstly, start by selecting the category based on the code’s average time for counseling-related visits. And make sure that the counseling meets the minimum threshold to assign a prolonged service code. Next, add an E/M and prolonged services code when you spend more than 70 minutes on an E/M visit. Also be certain that you select the E/M based on average time, add a prolonged services code when you spend extra time on monitoring and not counseling. And finally while coding for reimbursement make sure that you clearly mention the amount of time spent on monitoring or counseling separately.
The Road Ahead:
Time-based billing is a pretty long and tedious job. Going solo and opting to manage it on your own can be quite a stiff task. Hiring a proficient outsourced billing service provider can help you manage this task in a more streamlined way.