Making Sense of Time-based Coding

More than fifty percent of the face-to-face time a provider spends with their patient in a facility is required to be spent on the counseling or coordination of care when working with time-based coding. Most of you reading this likely already know that much on the topic. If you’re reading this, you probably also know that nothing in our world of coding and auditing is as simple as it seems, or should be.

Before a provider or coder can accurately code for time, there must be a fundamental knowledge and understanding of the average amount of time involved for a particular  service. Once that is understood, then you’ll need to properly account for time in your documentation. We recommend explicitly stating how much time was spent with the patient, face-to-face, then identifying how much of the total time was spent discussing their diagnosis and the prescribed treatment.

But still we find inconsistencies in the guidance provided by CPT^®. Take, for instance, that time is built into E/M codes. So, providers are taught to base their E/M code selections on the history, exam, and MDM, not on the time spent with the patient. And yet, CPT^® lists a variety of codes that are strictly time-dependent, and even has codes specifically for prolonged services.

Which leaves many of you (and us) scratching our heads around the importance of time, especially when we’re tasked with coding time-intensive office and inpatient visits.

Lucky for you, our motto around here is “find simplicity.” To that end, we created a brand new thought leadership asset called, “Time-Based Coding: A Healthicity Cheatsheet,” where we simplify the confusion around time-based coding, code by code, then provide  guidance on:

• CPT^® Midpoint Rule
• Time for Counseling and/or Coordination of Care
• Services That May be Coded Based on Time or Key Component

As a result, there is much confusion around the importance of time, especially when coding unusually long office and inpatient visits.