Billing and Coding is complex and certainly NOT a core medical competency for most doctors. The Precourse discussion by Martha Twaddle, Janet Bull and Christopher Acevedo was both timely and enlightening.
Here are some of the salient points from the talk:
- Look at complexity BEFORE coding Time!!
- If the clinician bills only on time you are losing money AND likely billing inappropriately!
- Use Extender codes if the visit exceeds typical time for the billed visit
- Always document WHY you are seeing the patient EVEN when making a follow up visit
- GIP level care cannot be used for caregiver breakdown anymore- this is an old CMS rule that was changed a few years ago; you MUST have a symptom to manage to bill for GIP
- For prolonged services you MUST use “in and out” times- these are additive: ex: if you see a patient from 9:15-9:45 and again from 3-3:30; total time is 60 minutes
Here are some additional resources from AAHPM on billing:
AAHPM Quick Reference Billing Guide (2006)
Tanya Stewart MD FAAHPM
The billing and coding workshop spent appropriately little time on the 40 minutes we lost from the highest level of time-based consultant billing, but also paid too much attention to complexity-based billing, in my opinion. Since much of the work I do as a palliative care consultant is counseling and care planning, and little of that face to face, prolonged service codes aren’t very useful to me, and I end up really trying to do the basic work of each consult inside that 70 minutes…which doesn’t leave much time for a complex exam, does it? So complexity-based billing doesn’t provide any advantage for that first visit. I’ll admit it’s worth thinking about complexity-based billing for subsequent visits, 99233s or 99310s in hospitals or nursing homes, respectively. So the issue of complexity-based vs time-based billing could be simplified: time-based for initial visits, complexity-based for subsequent visits.
Patrick Clary, MD
Medical Director Exeter Hospital Palliative Care (etc)