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Billing and Finance

In Reply To: Billing for family meetings + prolonged services
Next Reply: Re:Re:Billing for family meetings + prolonged service
Previous Message: Re:Billing for family meetings + prolonged services

Post Re:Billing for family meetings + prolonged service
Author: jeffzesiger
Date: May 3, 2009 9:58 pm
I am now being audited by Medicare for heavy use of 99255 and 99356,7. The first problem is they consider me an Internist still & not a Pall Care physician.
They are citing me for not putting "face to face time" on my 99356,7 even though I listed the start and end times clearly in the margin of each note.
They are down coding and asking for money back also for my 99255 consults because even though I list the start and end times, I did not write " greater than 50% of time spent in counseling and coordination of care" .
This is infuriating and takes up my time and adds to Work Burn Out.
As with other responses here I see Medicare asking for documentation often (~30% of the time) when I do 99356,7 work. So, I too just copy the note after I write it to have in case I need to send it to them. This is a waste of time !!!
Any one have the answer on how to respond to the audit?? I hope the new Hospice & PC code "17" from CMS will help
JeffZesiger
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Re:Re:Billing for family meetings + prolonged service (by JulieP on 05/06/2009)
Billing E/M services based on time requires you to indicate both the total time and the time spent counseling/coordinating care and what that counseling/coordination of care included. The documentation of in and out time only provides them with only half of the information. Generally when we are billing prolonged care the documentation by the providers states "Spent 60 minutes in family meeting, pt, spouse, children, SW & PC team all present discussed....." To me this signifies that they were face-to-face with the patient the entire 60 minutes. In a recent guide published by our Medicare carrier WPS, they clearly state that providers must indicate that they personally furnished the direct face-to-face time with the patient. I don't know what your documentation looks like, but if it was anything like what my providers indicate it's at least defensible. Now that your carrier has found that you have had deficiencies in your documentaiton they are likely to keep requesting the records each time you bill those codes. Keep your copies and once they determine you're doing things correctly they should back off.
Julie Pipke CPC, Reimbursement Mngr MCW

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