Time Based Billing

March 6, 2024 Volume 1, Issue 1

When duration of time spent to manage a patient encounter exceeds the time associated with the encounter’s level of Medical Decision Making (MDM), billing can be time based. This is true for both Outpatient and Inpatient Professional Fee codes.

Activities Included in Total Time

Documentation must reflect the activities performed on the day of service that contributed to the prolonged time spent. The time includes BOTH face-to-face and indirect patient care on the DAY OF SERVICE.

Activities counted in Total Time include:

· Preparing to see the patient (review of tests)

· Obtaining and/or reviewing separately obtained history

· Performing medically appropriate examination

· Counseling and educating the patient/family/caregiver

· Ordering medications, tests, or procedures

· Referring/communicating with other health care

· professionals (When not separately reported)

· Documenting information in the EMR

· Independently Interpreting results (if not reported separately) and communicating results to the patient/family/caregiver

· Care Coordination (if not reported separately)

Prolonged Time Billing

When Total Time on care for the Primary Service exceeds the highest level of service by at least 15 minutes, then prolonged time code(s) should be added on. Prolonged time codes are used in 15-minute increments.

OUTPATIENT PROLONGED TIME CODE: 99417
May be used with:

· New Patient Visit (99205)

· Established Patient Visit (99215)

· Consultation Patient Visit (99245)

INPATIENT PROLONGED TIME CODE: 99418
May be used with:

· Initial Patient Evaluation (99223)

· Subsequent Patient Evaluation (99233)

· Same Day Admit & Discharge (99236)

· Consultation Evaluation (99255)

Prolonged Time Codes may NOT be used in conjunction with CPT codes for:

· Critical care

· Counseling & coordination of care

· Prolonged care

· Hospital discharge service

Prolonged Time Example

A provider spends 20 minutes before an established patient visit reviewing the patient’s medical record, which includes a recent prolonged hospitalization.

The provider spends 40 minutes face-to-face with the patient and parents on counseling.

Another 15 minutes after the visit on the same day is spent completing documentation.

The total time spent of on the day of encounter is 75 minutes.

REPORT:
99215 (Established Patient Visit, 40 minutes)

+99417 (Prolonged time for 55-69 minutes)

+99417 (Prolonged time for 70-84 minutes)

**Every 15 minutes of prolonged time is coded with a unit on 99417.

Activities That Do Not Count in Total Time

· Documenting the day before the encounter

· Reviewing chart notes the day before the encounter

· Documenting the day after the encounter

· Time spent by clinical staff cannot be counted

· Resident/fellow time spent does not count

· The performance of other separately reported services

· Travel

· Teaching that is general & not limited to discussion that is required for the management of a specific patient

Time Based Billing Tidbits

· When considering how to best level your patient visits, Time Based Billing may or may not best fit the visit. If the visit was brief, but had higher level Medical Decision Making (MDM) in 2 of 3 elements, then use MDM. Use whichever method of leveling (Time vs. MDM) is more advantageous to you.

· Make sure you document how your time was spent to help reflect the intensity of services that took time to deliver for your patients. Higher level time must be supported!

· You do NOT need document stop and/or start times for patient care.

· Be reasonable in tallying up your time. There are only 24 hours in a day!

· Your time spent may be approximate, you do not need to be precise and start using a stop watch! Just be careful not to use the same approximation for every visit/level.

When using time, your total time in care on the
date of encounter should meet or exceed
the total time listed for the level of service coded.