Physician's Coding Strategist-Time can play a role in new guidelines

Legal guardians recognized

The American Medical Association (AMA) has clarified its evaluation and management instructions on how to use time as a way to select a level of service when counseling or coordination of care dominates the encounter — or accounts for more than 50% of the interaction.

Brett Baker, a reimbursement expert with the American College of Physicians-American Society of Internal Medicine in Philadelphia, notes that, specifically, the new counseling and/or coordination of care time guidelines now include "time spent with parties who have assumed responsibility for the care of the patient or decision making whether or not they are family members (e.g., foster parents, person acting in locum parentis, legal guardians)."

"It is important to note that your third-party payer may accept or reject this clarifying language," reminds Baker. In turn, you should check to see which payers are accepting this revision and reimbursing time spent counseling or coordinating care with non-family members.

The AMA also has instituted revisions intended to help resolve some longtime questions about critical care coding. For instance, the word "unstable" and the phrase "requiring the constant attendance of a physician" are deleted from the descriptor for code 99291, Baker says. The time designations in the code descriptors also were revised to correlate with the instructions for reporting a critical care service of less than 30 minutes.

"The revised descriptor for code 99291 specifies that a critical care service must be at least 30 minutes long to be reported using a critical care code. The previous descriptor was less clear. It stated that code 99291 could be reported for the 'first hour' of critical care," Baker notes.

The code now reads: "99291 Critical care, evaluation and management of the critically ill or critically injured patient, first 30-74 minutes."

Code 99292 is an add-on code that describes each additional 30 minutes of a critical care service. It should be listed separately and in addition to code 99291.