As published in JAMA Network Open, researchers with the University of Chicago and Oregon Health & Science University sought to quantify whether time-based billing can generate more revenue compared with billing that’s based on medical decision-making as reflected in CPT codes. “Studies show that physicians spend substantial time doing work that is not explicitly reportable by the E/M system of MDM-based billing, including medical record review, documentation, and coordination of care,” the researchers wrote. “As a result, many physicians report averaging one to two hours of unreimbursed, after-work hours daily.”
Meanwhile, 2021 changes to E/M guidelines “allow physicians to bill for face-to-face time and for previously unreimbursed time spent on medical record review, documentation and coordination of care on the day of the patient encounter.” CPT states, “When counseling and/or coordination of care dominates (more than 50%) the physician/patient and/or family encounter (face-to-face time in the office or other outpatient setting or floor/unit time in the hospital or nursing facility), then time may be considered the key or controlling factor to qualify for a particular level of E/M services.” This means that time alone can be used to select a level of care, regardless of the extent of the history, exam, or the medical-decision making, if the majority of the encounter involves counseling or coordination of care. For E/M services, counseling may include a discussion of test results, diagnostic or treatment recommendations, prognosis, risks, and benefits of management options, instructions, education, compliance, or risk-factor reduction.
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