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Time-Based Services
- Please define rules for using time to level-set a service.
Answer: In both the office and observation/inpatient setting, the provider’s time is calculated based on pre-visit, intra-visit, and post-visit activities relative to the patient’s care. This time does not need to reflect counseling and/or coordination of care. This rule also applies to split/shared inpatient services. - Can clinical staff time be counted in calculating time?
Answer: Time spent separately by clinical staff is not included in calculating time. - When more than one clinician (e.g., physician and QHP) see the patient jointly, how is time calculated?
Answer: When more than one clinician are performing the visit time jointly, time spent is only counted once. - What face-to-face provider activities may be counted in calculating time?
Answer: Time spent on the same date of service in obtaining and/or reviewing prior history, performing a medically necessary examination, formulating a medical decision and place of care, time spent in counseling and educating the patient/family/caregiver may all be counted toward total face-to-face time. - What non-face-to-face provider activities may be counted in calculating time?
Answer: Time spent on the same date of service in preparing to see the patient (e.g., reviewing data and records), ordering medications, tests and/or procedures, referring and/or communicating with other health care professionals, documenting clinical information in the medical record, independently interpreting test results (those not reported separately) and communicating that information to the patient/family/caregiver and care coordination may all be counted in calculating time. - Does time need to be spent contiguously or may time on a particular date of service be counted cumulatively?
Answer: Time on a particular date of service, spent on any of the face-to-face or non face-to-face activities defined here, may be counted cumulatively in coding a service.
Reviewed 4/15/2024