Wiki 21 minute est pt EM visit based in time

[1073358]

If all the criteria is met for billing based on time and the total visit was 21 minutes, would you bill a 99213 or a 99214?
CPT says 99213 is typically 15 min and a 99214 typically 25 min. So what if you are in between? Along with an answer, I need resources to back up the statements, so I can take to other people at my job. Please provide me direct links to info stating how to handle this. Thanks in advance!

 

[TonyaMichelle]

In the Cpt manual guidelines under "Select the Appropriate Level of E/M Services Based on the Following" in paragraph #3 it states:

"When counseling and/or coordination of care dominates (more than 50%) the physician/patient and/or family encounter (face to face time in the office or other outpatient setting or floor/unit time in the hospital or nursing facility), then time shall be considered the key or controlling factor to qualify for a particular level of E/M services. This includes time spent with parties who have assumed responsibility for the care of the patient or decision making whether or not they are family members (eg. foster parents, person acting in loco parentis, legal guardian). The extent of counseling and/or coordination of care must be documented."

So, if the physician spent even one minute over the E/M time specified, the next highest should be used. Example (99213 = 15 minutes face to face time with physician, then the physician face to face time is 16 minutes or more within this code family, the next highest E/M code will default, but the necessity of the time spent has to be documented.

Hope this helps...Happy Thanksgiving!!

 

[mdoyle53]

When using time for the key component, you have to meet the average time of the visit in order to use that code. Therefore in your situation, you would code a 99213. In order to code a 99214, 25 minutes of total time.