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We are a hospital based outpatient wound & hyperbaric center. We were told by our hospital coder that we can bill our patient visits based on either time or element complexity. In addition, one of these coding methods will need be used across all the patient visits and providers. In essence, we cannot change our billing method case by case. She stated if you decide to bill your charts based on time spent, all the charts will uniformly need to be coded in this manner. Essentially, we will not be able to code one chart based on time, and another one based on complexity elements. Is this correct?
Appreciated,
Bill
Aug 27, 2024 by Bill Khoury,
1 replies
Tiffany Hamm
BSN, RN, CWS, ACHRN, UHMSADS

Hi Dr. Khoury,

Thank you for the question. I believe you should circle back around to the billing department lead administrator and inquire if this is a system wide/hospital specific policy rather than a CMS regulation. Please refer to our topic: 2021 Office/Outpatient E/M Services Updates for Wound Care and HBOT


https://woundreference.com/app/topic?id=2021-officeoutpatient-em-services

"physicians can bill Evaluation and Management (E/M) encounters based on both medical decision-making (MDM) and time spent on the encounter."

Please let me know if you have further questions after speaking with them.

Kind regards,

Tiffany


Aug 28, 2024
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