Wiki E&M coding based on time

[dgivens10@aol.com]

When time spent falls between two typical times can you choose the CPT closer to the time spent? Example 99213 is 15 min and 99214 is 25 min. The provider spends 21 min. Which is the correct code. My understanding is you can not round to the closest that the provider would need to spend at least the designated time.

 

[Cathy Urbas]

Time Spent

When selecting an E&M code based on time, code selection is determined by 2 sets of time: the total face-to-face encounter time, and the amount of time spent in counseling and coordination of care. Did the provider spend a total of 21 minutes and if so, how much was in counseling/coordination of care?

 

[dgivens10@aol.com]

Thank you for responding. Yes 50% of the 21 minutes would have been spent counseling and coordinating care

 

[thomas7331]

The Medicare Claims Processing Manual gives this guidance in the section on E&M service codes:

"When an evaluation and management service is dominated by counseling and/or coordination of care (the counseling and/or coordination of care represents more than 50% of the total time with the patient) in a face-to-face encounter between the physician or qualified NPP and the patient in the office/clinic or the floor time (in the scenario of an inpatient service), then the evaluation and management code is selected based on the typical/average time associated with the code levels. The time approximation must meet or exceed the specific CPT code billed (determined by the typical/average time associated with the evaluation and management code) and should not be “rounded” to the next higher level."