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Hello,

I have a quick question regarding E/M coding by time. If an established outpatient patient was seen for a total visit time of 35 minutes and more than 50% was spent counseling etc., could I code a 99215 which is for visits of 40 minutes or must I code a 99214 - for visits of 25 minutes?

Thank you for you help.
 
In our February Coders Edge Magazine, page 31 adresses this issue. It states: CPT states this rule (time-based) as, "When codes are ranked in sequential typical times and the actual time is between two typical times, the code with the typical time closest to the actual time is used".
So, if time spent with patient is 35 minutes, wouldn't that be closer to a 99215 (40 minutes) than the lesser code 99214 (25 minutes), especially considering the physician spent 50% of his time counseling?
Hope this helps:):)
 
What if the visit time for an established patient was 20 minutes? That is right in between 99213 - 15 minutes and 99214 - 25 minutes. Thank you.
 
I was wondering if the guidelines for billing E/M for timing allows you to bill for services such as obtaining a history, performing an examination and counseling the patient. If my provider were to document -
"40/50 min time spent reviewing patient history with the patient." Would this be a 99215?

Thank you
B.Repar
 
One other consideration....

One other consideration when determining the level of service by time is who the insurance carrier is. At the practice I work at all of our insurances allow us to round up (however if like the example above the time is in the middle we don't, so 20 mins would still be a 99213 but 21 and above would be a 99214) EXCEPT for Medicare where you have to have at least the amount of time required for the level.
 
If this came across my desk in an audit, based on time alone I would deny it as a level 5 unless at least 40 minutes were spent face-to-face with the patient or family. IMO if the condition(s) is/are so complicated that the provider believes they should get a level 5, they need to document the reasons why.
 
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