Question

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

Answer 1

There are many reasons why the provider simply can not code office visits by time spent with the patient. According to the federal healthcare guidlines, an authorized physician has an obligation to justify a patient's visit by taking proper medical history, examination and taking appropriate medical decision whatever is needed. 15 minutes is what 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 atleast 25-30 minutes for all the assessments, medications and counseling but there is no need of an extensive examination or complicated medical decision to make. Another example can be a patient with asthma attack who can potentially take 1-2 hours for the whole procedure or intervention. One more example can be a patient who need a physiologic monitoring like maternal fetal. So in all the three cases, there is mandatory requirement of time even if the condition is not that complex. Hence, the office visits of these patient can not be coded on the basis of time. Apart from these, there can be other situations like a patient undergoing an annual physical check up and the physician counsel him/her about a newly discovered medical concerns such as how to play safe prevent an exposure to corona. Sometimes the healthcare facility itself put the patient on standby in order to decide if a 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.