What should you do to report more than six procedures or services for the same date of service?

Time tracking tips

Delaying the completion of your notes is not usually recommended. But some cases lend themselves to this. If the record review will take extended period, it might be worthwhile to prioritize doing that work on the visit date, if that fits into your workflow. If you anticipate discussing a case with another clinician (or independently interpreting a test) and that time will change your visit level, it may be appropriate to delay signing off on that record.

Keeping track of time is burdensome, leading many of us to forego time-based codes. But those minutes can add up. Some EHRs have timers that automatically track when you’re logged in to a patient's chart, which is imperfect, but helpful. If your system has this feature, make sure the EHR chart is open while you’re reviewing records (and take some notes about that review in the chart) before the visit, and make sure it’s open during the visit as well.

It's also a lot easier if you have the chart open during phone calls. You can add notes during or right after the call summarizing your time and discussion. It is not reasonable to expect that you have a timer logging your every movement in case you need it for coding. Small increments (1-2 minutes) are difficult to track and often don’t’ seem worth the effort to keep up with, so admittedly are easy to "lose." But if you end up on a phone conversation without the EHR tracker going, it's often worth glancing at the call time on your phone and recording that time as well.

If you make a good faith estimate of the time spent on behalf of a patient on the date of the visit and it lands close to the point where it crosses over to the next level and a higher charge, I would err on the side of caution and choose the lower level. But unless you consistently and frequently code 99215 (time range 40-54 min) with an estimated total time of 40 minutes, this is not likely to be an issue.

Some common tasks may be physically impossible for you to complete in less than a certain amount of time, which makes it easier to record. For example, my state requires physicians to check the Prescription Drug Monitoring Program (PDMP) when we prescribe controlled substances. While it sometimes takes longer, this task is never less than two minutes for me. Other recurrent tasks that may have a specific "base time" for you might include specific types of phone calls (e.g. pharmacy), certain referral tasks, or specific documentation activities (e.g. Family Medical Leave Act paperwork).

Some things just don't lend themselves to time tracking, like results review. But if your total time is going up toward the threshold for a higher level visit, then by all means, add in that couple minutes.

Example

A 76-year-old established patient with mild to moderate dementia, who lives in an assisted living facility, presents with confusion related to her medication regimen. She also has diabetes and hypertension. Pill counts are performed during the visit and records from an urgent care center are reviewed. The physician also reviews medication pick-up history with the pharmacist. In addition to periodic urgent care visits with medication changes, the physician discovers erratic refill patterns. The physician has a phone call with the patient’s family member who has power of attorney (POA) and helps with a pill planner. They discuss medication adjustments, and a plan to shift the patient’s medication administration to “supervised.”

Here's how the time for each activity could break down, and how the physician or QHP could track it.