Part B Insider (Multispecialty) Coding Alert

Question: If a doctor bills a 99204 based on time (45 minute visit with more than 50 percent spent in counseling/coordination of care) and also performs a flexible laryngoscopy during the encounter, does he have to subtract the time he spent performing the scope from the time he spent in counseling/coordination of care?

Answer: Yes, you’ll need to list two times for the encounter associated with 99204 (Office or other outpatient visit for the evaluation and management of a new patient …): the total time for the E/M (not counting the scope time) and the time spent counseling. You need to indicate that the total visit was X minutes and that counseling for the patient was Y minutes and the reasons for the counseling. For example, your physician might state that the counseling was for the following issues: 

• Surgical options 
• Pre-op instructions if surgery is selected 
• Anticipated post-op healing time and pain level as well as pain medication that will be provided 
• The need for the patient to stop smoking, in particular for up to 8 weeks post-op.

Plus: Since Y minutes are more than X minutes, you can code the visit based on time with the level based on the total minutes of X. You cannot round up, so select the level that it is closest to the actual minutes, knowing you may have to round down a code.  For example, if X is 34 minutes, you need to code 99214 (which has a reference time of 25 minutes). You cannot round up to 99215 (which has a reference time of 40 minutes).