Ophthalmology and Optometry Coding Alert

Question: Our ophthalmologist spent 40 minutes face-to-face with a patient and documented spending 15 minutes counseling the patient about how her diabetes is affecting her eye health. Which E/M code should I use?

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Answer: There are two ways to answer this. If coding by time, you would have to code 99214 (Office or other outpatient visit for the evaluation and management of an established patient. … Typically, 25 minutes are spent face-to-face with the patient and/or family), because although the total visit time was 40 minutes, which is the threshold for 99215 […  Typically, 40 minutes are spent face-to-face with the patient and/or family.], the counseling was only 15 minutes. To code 99215, the time would have to be more than 21 minutes, or over 50 percent of 40 minutes.

If your history, exam, and/or medical decision-making support reporting 99215, then you should report the code based on those elements rather than the time spent. If they don’t, then you’ll need to report 99214 in this situation since you don’t have enough time spent counseling to support 99215.