Question

3. Why can't the provider simply code office visits by time spent with the patient?

Answer 1

There are many reasons why the provider can not code office visits by time spent with the patient. According to the federal healthcare guidelines, an authorized physician has an obligation to justify a patient's visit by taking proper medical history, examination and making appropriate medical decisions whatever is needed. 15 minutes is what has been recognized as the standard time for most of the time-based E/M codes. But there can be situations where the doctor gets a patient with a condition that requires at least 25-30 minutes for all the assessments, medications, and counseling. Still, there is no need for an extensive examination or complicated medical decision to make. Another example can be a patient with an asthma attack who can take 1-2 hours for the whole procedure or intervention. One more example can be a patient who needs physiologic monitoring like a maternal-fetal. So, there is a mandatory requirement of time in all three cases, even if the condition is not that complex. Hence, the office visits of this patient can not be coded based on time. Apart from these, there can be other situations like a patient undergoing an annual physical check-up. The physician counsels him/her about newly discovered medical concerns such as playing safe prevent exposure to corona. Sometimes the healthcare facility itself puts the patient on standby to decide if surgery is required for the current medical condition or not. So in these cases, also, time is not what a patient should be charged for.