Billing a PE and E&M (based on time)

I work for Primary Care Physicians. We have a physician that sees a patient for their PE visit and then when they are also billing an E&M for acute or chronic conditions where they have changed a medication, have new problem, added a new medication etc... instead of billing the E&M on MDM, they are documenting "Time" they spent on each of those conditions and when it adds up to 40 minutes, they want to bill a Level 5 with the PE code. The Level 5 is only based on the time and not MDM. I have not found clear guidelines that a Dr can not bill an E&M along with a PE based on "Time" if they clearly document the time spent on those Acute or Chronic conditions. Does anyone have more information.

Since CPT does not assign a time for a PE, you cannot bill a PE based on time alone. You can bill the E&M based on time, but there needs to be a statement that validates that none of the time spent on the E&M was performing any work on the well visit. Separate notes are generally suggested.

Ok, Thank you for replying. I knew the PE did not have a time associated with it. The Dr will document for example: 25 minutes were spent on the annual physical, including age-appropriate screening review, immunizations, and preventive counseling. An additional 45 minutes were spent on the date of the service, including chart review, patient evaluation, documentation and care coordination for non preventive aspects of the visit, which include management of HLD (10min), HH (10Min), hx of mild TR(10 min), osteopenia (5min), hx of colon polyps (5min) and evaluation of easy bruising (5min). This is at the summary of the A&P. What is your thought on this?

No, because there's no time assigned to the PE. The 25 minutes spent on the physical is not a valid support of the service.

In this case, I'd code based on MDM for the E&M as long as it's significant and separately identifiable from the PE to support the -25 modifier. That means that a significant issue was found during the PE or there's a chronic condition present that requires additional workup, a change in care plan, a prescription change, or significant exacerbation. Otherwise, it's part of the PE. The numerous Dx above; management of HDL, (did he change the treatment plan) MILD osteopenia, (mild is not significant), did the evaluation of bruising result in bloodwork for clotting factors?, etc, Hx of colon polyps (what treatment was done; that's just a comment), all really aren't significant enough for the additional E&M.
From CPT Assistant, March 2023: These instructions should be reviewed in detail to understand the appropriate use of modifier 25. For example, in the case of preventive medicine services, if an abnormality is encountered or a preexisting problem is addressed in the process of performing a preventive medicine E/M service, and if the problem or abnormality is significant enough to require additional work to perform the key components of a problem-oriented E/M service, then the appropriate office or other outpatient visit E/M code (99202-99205, 99212-99215) should also be reported. Modifier 25 should be appended to the office or other outpatient visit code to indicate that a significant, separately identifiable E/M service was provided on the same date as the preventive medicine E/M service, and the appropriate preventive medicine E/M service is additionally reported without a modifier. In contrast, if an insignificant or trivial problem or abnormality is encountered during a preventive medicine E/M service that does not require significant additional work, then a separate office or other outpatient visit code should not additionally be reported.
•Significant, separately identifiable E/M services should be documented. A significant, separately identifiable E/M service is defined or substantiated by documentation that satisfies the relevant criteria for the respective E/M service to be reported.