I’m an oncologist who sees 18-20 fairly complex cases per day, 4-5 days a week. I see anywhere from 4-6 new patients with the rest follow-ups. It takes a LOT of time to prepare for the visits, come up with treatment plans and then make a detailed summary in my documentation after each visit. The fact that I have to do all of my documentation and chart review the same day in order to bill for it has been infuriating me to no end. Sure, I can chart review the night before and finish my notes the following day, but I cannot legally bill for that time. However, if I chart review at 12:01am and finish my notes by 11:59pm of the same day, it’s fair game. That is ridiculous and this should change.
A lawyer, for instance, bills me for every word they read from me in an email, regardless of when they decide to read that email. We should be able to bill for our time working regardless of when we spent that time working.
Edit: I know about billing by complexity, and I do it when it’s appropriate. It doesn’t excuse the fact that billing for time only on the same day of service is wrong.
Bill based on time. Capture as much as you can from what you spent that day.
Honestly, if it’s pre-charting the night before, but you could have also woken up early and done it that day, it also makes sense to count it toward that day even if in reality it was the night before.
Use the extended time codes (15 minute blocks above 99205).
But it’s stupid.
By the way, this is for the new patients.
For the follow-ups, your time involved will be much lower even though the team, blood draws, chemo etc will be while you’re “around.” Unless there was a tumor board or additional imaging you reviews or something else that day to increase time, I imagine just billing the complexity is the more appropriate method.
I don’t know the history behind why that is the rule, but there is not a lot of appetite among the public or either political party to make it easier for doctors to make more money.
You can bill 99358/9 for record review and documentation on a different day but I don’t know how that is reimbursed.
I agree completely. It’s why I’ve limited my chart review and precharting. I still do it, but I’ve limited it to bare bones and try to do what I can the day of since I’m not getting paid for it otherwise.
99358 and 99359, as long as you are spending more than 30 minutes on chart review and creating some sort of documentation, can be billed before the encounter date. I’ve seen it done as a separate encounter which synthesizes the information necessary for a complex visit like an onc appt.
PREACH! I do so much of my reading of records on the weekend. Also, pt comes in, tells me they took themselves off to a specialist I knew nothing about. I won’t HAVE the record within the same day.
It’d be nice as a radiologist if I could bill like clinicians do based on patient complexity. It takes 5 minutes to read a head CT of the soccer mom with a headache but 30 minutes for the post-op GBM case with a new headache. None of this stuff makes sense or is fair
Billing for time is the most straight forward but not the best in the long run. Bill by medical decision making. Do you have epic? there’s a LOS calculator /wizard that will help you do that? Billing has really never been more straight forward since 2023.
I know about billing by complexity, and I do it when it’s appropriate.
You should be doing this virtually always IMO. Practically every one of your oncology patients has a life-threatening condition. MDM billing favors exactly this sort of patient. My practice is the same way and I bill maybe 5% of my encounters by time.
I know a Physician who did this and she and her partner went to jail. The real kicker at the trial when they brought up one instance where she billed more than 24 hours in a day when she was on vacation in Hawaii.
I agree with you. With regard to follow-ups, a level 5 is only 40 minutes of time. 20 min in the room and 20 min charting is not terrible to accomplish I suppose