Counseling & Education--50% of time


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Can anyone tell me a typical way to code for an E/M visit whereas 50% or more of the time spent in the prenatal visit is spent on counseling and education?

Is it more typical to choose one of the higher E/M level codes or would it just as accurate to code a lower E/M visit based on the level of history, exam and MDM and THEN add 99354 for Prolonged Face to Face?

The practice I work for is a birth center with Midwives and they give extensive counseling and educational guidance on a routine basis. I just don't want to trigger an audit due to consistently coding a high E/M code.

Any suggestions or knowledge in this area? Thank you in advance!


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Time- based

You are allowed to consider each coding option and select the best/accurate one. If the patient is scheduled for an offce visit that includes evaluation and management but results in more than 50% counseling, code based on time. If the documentation supports a higher level code and meets medical necessity, feel confident coding the visit as such.

I, personally, would be hesitant to use a prolonged services code. 1) this code indicates increased work and/or effort on behalf of the provider, which doesnt seem to be the case as you use the term "routine" to describe these visits at your practice. 2) use of Typical E/M coding guidelines or time based coding, should be able to capture the nature of the visit adequately, so no real need to use the modifier.

Anyway, just my thoughts