Reader Question: Billing for Patient Education

Question: We spend a lot of time teaching patients how to self-administer allergy injections and providing them with educational information and training. How does this factor in to billing for time spent in the E/M visit?

ACQ Subscriber

Answer: When counseling or coordination of care constitutes more than 50 percent of the encounter, time can be considered the controlling factor in determining the level of E/M services. It is important to fully document the counseling in the patient's medical records.

If counseling does take up more than 50 percent of the session, you can bill based on time versus the key components. For example, use 99213 for a level-three visit for an established patient. The time component for this is 15 minutes. Therefore, if a PA spends 50 percent of a 15-minute office visit counseling a patient, code 99213 may be used even if the criteria for the key components (history, examination and decision-making) are not met.

Be careful to comply with CPT guidelines concerning counseling. Education and counseling can encompass only seven activities: