Awareness : Did You Know? 2015-2016

Did You Know? Weekly Educational Series 43

For The Week of August 22, 2016

Time-Based Coding:

Many times auditors see statements to the effect of “xx minutes spent face to face with the patient, greater than 50% of the time spent counseling and coordination of care”….and there it stops. It is all too easy to say, “That shows face-to-face time with the majority spent counseling,” and move on through a compliance audit without stopping to look at the big picture.


Auditors must scrutinize documentation to determine if the provider is appropriately billing a time-based visit, as well as if the focus of the time-based documentation is present and justifies the medical necessity of the counseling-based service.

A time-based visit may be excellently suited for outlining a cancer treatment plan following an undesirable biopsy report, when medication and survivability are being discussed, and the patient is not acutely ill.

It may not be appropriate, however, for every single cancer treatment follow-up the patient receives, especially if there’s marked improvement and/or no change in the patient’s overall status. It would be inappropriate to allow time-based billing just because the provider’s statement “checks all the boxes” but may not demonstrate the need for such a service.