Time Reporting for E/M Levels

Question:

My physician is billing office visits 99202-99215 based on time only.  Is this best practice?

Answer:

The E/M services 99202-99205 are based on either medical decision making or time.. Practitioners may choose to either bill by time or medical decision making. The practitioner should evaluate each patient encounter to determine which method is more advantageous. If time is used to calculate the E/M service, the total time should include all work associated with the patient encounter on the date of service. KZA recommends that the practitioner document an attestation statement itemizing the time spent on the specific activities for the patient. Example:. “This encounter took 45 minutes of time including taking a history, performing the examination, reviewing the CT scan, reviewing the PCP’s notes, counseling the patient on the conditions treated formulating a plan of care as well as documenting in the EHR.”

Shared Visits in the Hospital for Medicare

Question:

I have a question regarding 2023 shared visit rules. I am reviewing an E&M note where I will select the level of E&M based on the MDM being the substantive part and not time. My question: does each provider have to document their individual time if not a factor in the level of E&M I recommend?

Answer:

No, the documentation of time is not required if Time will not be a determining factor in E&M code selection.

CMS has delayed the implementation of Time as driver for defining the substantive part of the shared encounter until January 2024.

The following excerpt is from the Final Rule published in November 2022.

Page 212:
“After consideration of public feedback, we proposed to delay implementation of our definition of the substantive portion as more than half of the total time until January 1, 2024. We continued to believe it is appropriate to define the substantive portion of a split (or shared) service as more than half of the total time, and proposed that this policy will be effective beginning January 1, 2024….”

You may consider working with your providers to start documenting time should CMS move forward with a final implementation of Time as the driver of substantive time in 2024. This would allow them to become familiar with including this in their notes, while informational at this time, if the code is to be selected on the MDM and not time.

E/M Coding Based on Time

Question:

Our physicians’ defaults to time for almost every office encounter. We are working with them on documentation and what work contributes to total time and what does not. They perform their own independent interpretation of X-Rays (we bill globally) and performs procedures such as for example a shoulder injection or a genicular nerve injection in the office. They are counting the total time spent with the patient, including these activities and we do not believe that is correct. Can you help?

Answer:

Thank you for your inquiry. We will not address the default to time for almost every encounter other than to say medical necessity must be present for time spent. With that said, the activities you identify, because they are billable services represented by other CPT codes (aka are separately reported), do not contribute to the total time spent; this time must be deducted from the total time, assuming the E/M service is reportable.

Modifier Order on CMS Claim Form

Question:

We are submitting a hospital claim form with the modifier 25 and FS modifier. We are unsure which modifier to list first. What is your recommendation?

Answer:

Thanks for contacting KZA and remembering to use the FS modifier for shared services provided in the hospital. KZA recommends placing modifier 25 first, as this is considered a reimbursement modifier followed by the FS modifier, which is an informational modifier.

Chemodenervation with Needle Electromyography

Question:

My doctor performed chemodenervation on all four extremities using needle electromyography. We use CPT code 95874 for the electromyography. My question is do I only report CPT 95874 once for all 4 extremities or can I report 95874 it for each extremity. Do I need to add Modifier 59?

Answer:

Yes, you can report needle electromyography with chemodenervation for each extremity. However, report only one guidance code per chemodenervation code.

Somatic Nerve Injections

Question:

When reporting an injection of a steroid of the brachial plexus can I report imaging such as ultrasound guidance?

Answer:

CPT code 64415 is reported for a injection of an anesthetic agent and/or steroid of the brachial plexus. Per CPT imaging guidance is included in the code and cannot be reported with CPT codes 76942, 77002 or 77003.