Ob-Gyn Coding Alert

When choosing which E/M code to use for a particular service, coders must check to see whether the service provided meets the three key components for that coding levelhistory, examination and medical decision-making. But when the physician spends more than 50 percent of his or her time counseling the patient during any particular face-to-face meeting, then time, rather than the other components, is considered the most important factor in determining the E/M code.

The CPT manual clarifies this point on page 8 of the 1999 edition in point #3, which states: In the case where counseling and/or coordination of care dominates more than 50 percent of the physician/patient and/or family encounter (face-to-face time in the office or other outpatient setting), then time is considered the key or controlling factor to qualify for a particular level of E/M services.

What this means is that ob/gyns who spend a great deal of time counseling patients on treatment and life-style issues (i.e. contraception, STD prevention, infertility, etc.), may be able to code these visits at a higher level than it might at first appear based solely on history, examination and medical-decision making. A higher level E/M code also would increase the typical time allotted to the visit, and may affect coding for Prolonged Services. Coders would be wise to consider both methods of coding for counseling encounters, and the anticipated payment for each (a higher E/M code versus a lesser E/M code plus a Prolonged Services code) prior to submitting their claims for reimbursement.