Billing and Coding is complex and certainly NOT a core medical competency for most doctors. The Precourse discussion by Martha Twaddle, Janet Bull and Christopher Acevedo was both timely and enlightening.

Here are some of the salient points from the talk:

  • Look at complexity BEFORE coding Time!!
  • If the clinician bills only on time you are losing money AND likely billing inappropriately!
  • Use Extender codes if the visit exceeds typical time for the billed visit
  • Always document WHY you are seeing the patient EVEN when making a follow up visit
  • GIP level care cannot be used for caregiver breakdown anymore- this is an old CMS rule that was changed a few years ago; you MUST have a symptom to manage to bill for GIP
  • For prolonged services you MUST use “in and out” times- these are additive: ex: if you see a patient from 9:15-9:45 and again from 3-3:30; total time is 60 minutes

Here are some additional resources from AAHPM on billing:

AAHPM Quick Reference Billing Guide (2006)


Tanya Stewart MD FAAHPM