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SAN DIEGO — The extra time required for prescribing isotretinoin under the iPLEDGE program need not go unreimbursed, Dr. Allan Wirtzer said at the annual meeting of the California Society of Dermatology and Dermatologic Surgery.
Coordinating a patient's isotretinoin care with the patient, family, and pharmacist, and fulfilling requirements of the federally mandated system often entail more work than the other components of a patient's visit, such as the history and the physical.
“It's important to remember that time can be used for coding when counseling and/or coordination of care constitutes more than 50% of the total physician encounter with patient and/or family,” said Dr. Wirtzer.
Therefore, clinicians should consider billing these visits according to the total time of the encounter, detailing in the patient's chart the type of counseling and coordination of care performed during those minutes, suggested Dr. Wirtzer, a dermatologist in private practice in Sherman Oaks, Calif., and chair of the American Academy of Dermatology's Task Force on Coding and Reimbursement.
He offered two chart notes that would justify a CPT billing code of 99214, using time as the criteria rather than details of the history, physical examination, and decision-making process:
▸ Extended discussion with mother and patient regarding causes of acne and treatment options—counseling 10 of 15 minutes.
▸ Documentation of pregnancy status and recent blood tests via the iPLEDGE program to coordinate the prescription of Accutane with the pharmacy—15 of 25 minutes.
“We're talking about face-to-face care in the office,” Dr. Wirtzer noted. “When the patient is in the office [and] you're putting information regarding Accutane into the computer [for iPLEDGE], that's time related to coordination of care, and it counts. But you have to document what you've done and how much time you spent.”
Calling a pharmacist after the patient has left the office cannot be included in the time contributing to billing for a visit using the 99214 code, he explained.
Dr. Wirtzer encouraged colleagues to be aware of the level of coding that would be supported by documenting key components of a visit (history, physical examination, decision making, etc.) and to compare that to the level the visit would qualify for if “time” was used as the determining factor.
The times specified for CPT reimbursement levels for established patients include 15 minutes for a 99213, 25 minutes for a 99214, and 40 minutes for a 99215.
SAN DIEGO — The extra time required for prescribing isotretinoin under the iPLEDGE program need not go unreimbursed, Dr. Allan Wirtzer said at the annual meeting of the California Society of Dermatology and Dermatologic Surgery.
Coordinating a patient's isotretinoin care with the patient, family, and pharmacist, and fulfilling requirements of the federally mandated system often entail more work than the other components of a patient's visit, such as the history and the physical.
“It's important to remember that time can be used for coding when counseling and/or coordination of care constitutes more than 50% of the total physician encounter with patient and/or family,” said Dr. Wirtzer.
Therefore, clinicians should consider billing these visits according to the total time of the encounter, detailing in the patient's chart the type of counseling and coordination of care performed during those minutes, suggested Dr. Wirtzer, a dermatologist in private practice in Sherman Oaks, Calif., and chair of the American Academy of Dermatology's Task Force on Coding and Reimbursement.
He offered two chart notes that would justify a CPT billing code of 99214, using time as the criteria rather than details of the history, physical examination, and decision-making process:
▸ Extended discussion with mother and patient regarding causes of acne and treatment options—counseling 10 of 15 minutes.
▸ Documentation of pregnancy status and recent blood tests via the iPLEDGE program to coordinate the prescription of Accutane with the pharmacy—15 of 25 minutes.
“We're talking about face-to-face care in the office,” Dr. Wirtzer noted. “When the patient is in the office [and] you're putting information regarding Accutane into the computer [for iPLEDGE], that's time related to coordination of care, and it counts. But you have to document what you've done and how much time you spent.”
Calling a pharmacist after the patient has left the office cannot be included in the time contributing to billing for a visit using the 99214 code, he explained.
Dr. Wirtzer encouraged colleagues to be aware of the level of coding that would be supported by documenting key components of a visit (history, physical examination, decision making, etc.) and to compare that to the level the visit would qualify for if “time” was used as the determining factor.
The times specified for CPT reimbursement levels for established patients include 15 minutes for a 99213, 25 minutes for a 99214, and 40 minutes for a 99215.
SAN DIEGO — The extra time required for prescribing isotretinoin under the iPLEDGE program need not go unreimbursed, Dr. Allan Wirtzer said at the annual meeting of the California Society of Dermatology and Dermatologic Surgery.
Coordinating a patient's isotretinoin care with the patient, family, and pharmacist, and fulfilling requirements of the federally mandated system often entail more work than the other components of a patient's visit, such as the history and the physical.
“It's important to remember that time can be used for coding when counseling and/or coordination of care constitutes more than 50% of the total physician encounter with patient and/or family,” said Dr. Wirtzer.
Therefore, clinicians should consider billing these visits according to the total time of the encounter, detailing in the patient's chart the type of counseling and coordination of care performed during those minutes, suggested Dr. Wirtzer, a dermatologist in private practice in Sherman Oaks, Calif., and chair of the American Academy of Dermatology's Task Force on Coding and Reimbursement.
He offered two chart notes that would justify a CPT billing code of 99214, using time as the criteria rather than details of the history, physical examination, and decision-making process:
▸ Extended discussion with mother and patient regarding causes of acne and treatment options—counseling 10 of 15 minutes.
▸ Documentation of pregnancy status and recent blood tests via the iPLEDGE program to coordinate the prescription of Accutane with the pharmacy—15 of 25 minutes.
“We're talking about face-to-face care in the office,” Dr. Wirtzer noted. “When the patient is in the office [and] you're putting information regarding Accutane into the computer [for iPLEDGE], that's time related to coordination of care, and it counts. But you have to document what you've done and how much time you spent.”
Calling a pharmacist after the patient has left the office cannot be included in the time contributing to billing for a visit using the 99214 code, he explained.
Dr. Wirtzer encouraged colleagues to be aware of the level of coding that would be supported by documenting key components of a visit (history, physical examination, decision making, etc.) and to compare that to the level the visit would qualify for if “time” was used as the determining factor.
The times specified for CPT reimbursement levels for established patients include 15 minutes for a 99213, 25 minutes for a 99214, and 40 minutes for a 99215.