Friday, July 9, 2010

Billing patient education and counseling to Medicare - Time limit

Billing For Visits When the Majority of the Visit is Spent Counseling:

If more than 50% of the time of the visit is spent in counseling or education, then you are able to bill according to the amount of time spent face-to-face with the patient. These are for patients that have a medical problem to begin with.
New Patients
99201          99202          99203           99204           99205
10 min.         20 min.         30 min.           45 min.         60 min.

Established Patients
99211          99212           99213                99214             99215
5 min.            10 min.        15 min                25 min           40 min.

Documentation requires that you list the total time of the visit, the time spent in counseling, and the subject discussed. Time can over-ride all other requirements.

Counseling ICD-9 Codes (These would be used secondary to the medical condition being treated.)
V65.3        Dietary surveillance and counseling (For this code there must be a problem also listed such as obesity, underweight, diabetes)

V65.43            Substance use/abuse (tobacco, drugs) (The code for the specific drug abuse should be listed, i.e. 305.1 tobacco abuse)

 V65.43           Injury prevention

V65.44              HIV

V65.45             STDs

V65.49             Other specified counseling
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Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.


Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)


Medicare Physician Fee Schedule Payment Rates Formula


The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF

Medicare fee schedule download