EM Coding Alert

Question: I noticed that the physicians at the practice I just started working at tend to bill office visits based on time. They perform in-office procedures, such as nasal endoscopy, sinus debridement, and laryngoscopy, and include the time spent on these services in the evaluation and management (E/M) total time count. I don’t think this is correct. Please advise.

Missouri Subscriber

Answer: The procedures you mentioned are billable services represented by other CPT^® codes — these activities are reported separately and may not contribute to the total time count for a billed E/M service. In other words, you must deduct the procedure time from the total time, assuming the E/M service is reportable.

The Centers for Medicare & Medicaid Services (CMS) expects the E/M to consume time separate from the time it takes for the minor procedure. To know what’s allowed, refer to the physician work time file for 2024, which indicates the amount of time the provider may expend for minor procedures pre-service, intra-service, and post-service activities, at www.cms.gov/medicare/medicare-fee-service-payment/physicianfeesched/pfs-federal-regulation-notices/cms-1784-f.