# E/M service based on time



## dzarick1 (Feb 7, 2011)

At this years AMA CPT Symposium under E/M education by Dr. Hollmann, one of his slides states "if coding by time, pick the closest typical time."  Does this mean that for a new patient visit that is 40 minutes face to face by the provider and greater than 50% of the visit time is spent counseling and/or coordinating care that this would support a 99204?


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## mitchellde (Feb 7, 2011)

I do not have my book in front of me but if 40 minutes is the time stated in the CPT book for a 99204 then yes.  If it is stated as 45 minutes for a 99204 then no.


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## FTessaBartels (Feb 8, 2011)

*Yes ..*

Our Compliance department revised the guidelines for E/M coding to reflect this change.

The AMA is *trying* to be consistent in re how to address time.  Look at how they count "the first hour" for critical care as an example ... it's 30-74 minutes.  They've used the "round up or down" principle for critical care coding (and prolonged service) for quite some time and they have extended that to the typical times for E/M codes. 

So for the typical times for E/M:
99203 is listed as 30 minutes
99204 is listed as 45 minutes
The difference in time is 15 minutes ... so once you've gone past the half-way point you round up to the next increment  (effectively any time from 38-52 mintues)

That's a more complicated way of putting it than to pick the "typical" time that is closest to the actual time, but it's the same result. 

Hope that made sense. 

F Tessa Bartels, CPC, CMEC


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