I took it to mean that the provider provided a wellness exam and then a separate, identifiable problem oriented service was also provided.
CPT Assistant states:
“When counseling and/or coordination of care constitute more than 50% of the physician/patient and/or family encounter (face-to-face time in the office or other outpatient setting or unit/floor time in the hospital or nursing facility) time may be considered the key or controlling factor to qualify for a particular level of E/M service.”
"If counseling and/or coordination of care did dominate the visit, then the code is selected based on the total time of the face-to-face physician/ patient (and/or caregiver) encounter (or total floor/unit time in the hospital or nursing facility setting). It is important to note that not all codes have typical times (eg, domicilliary care). In such cases, time may not be used to select the code. In selecting time, the physician must have spent a time closest to the code selected. For example, 99214 has a typical time of 25 minutes and 99213 has a typical time of 15 minutes. If the face-to-face office time is 21 minutes, code 99214 would be selected as it is more than half of the time difference."
Example:
Physician A discusses insulin-dependent diabetes with the patient, reviewing the importance of diet and exercise, proper insulin administration, and the home management of hypoglycemic reactions. The total time Physician A spends with Mrs Smith is 25 minutes, 15 minutes of which is counseling. Although Physician A performed all three of the key components, counseling clearly dominated the service and can be considered the controlling factor. In this example, it would be appropriate to report code 99214 based on the total 25 minutes spent face-to-face by Physician A with Mrs Smith, of which more than half was spent counseling. Of course, Physician A's documentation should indicate both the extent of the counseling he provided at this encounter as well as the total time and the time counseling during the visit.
