At this years AMA CPT Symposium under E/M education by Dr. Hollmann, one of his slides states "if coding by time, pick the closest typical time." Does this mean that for a new patient visit that is 40 minutes face to face by the provider and greater than 50% of the visit time is spent counseling and/or coordinating care that this would support a 99204?
-
If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..
Wiki E/M service based on time
- Thread starter dzarick1
- Start date
mitchellde
True Blue
I do not have my book in front of me but if 40 minutes is the time stated in the CPT book for a 99204 then yes. If it is stated as 45 minutes for a 99204 then no.
FTessaBartels
Guest
Yes ..
Our Compliance department revised the guidelines for E/M coding to reflect this change.
The AMA is trying to be consistent in re how to address time. Look at how they count "the first hour" for critical care as an example ... it's 30-74 minutes. They've used the "round up or down" principle for critical care coding (and prolonged service) for quite some time and they have extended that to the typical times for E/M codes.
So for the typical times for E/M:
99203 is listed as 30 minutes
99204 is listed as 45 minutes
The difference in time is 15 minutes ... so once you've gone past the half-way point you round up to the next increment (effectively any time from 38-52 mintues)
That's a more complicated way of putting it than to pick the "typical" time that is closest to the actual time, but it's the same result.
Hope that made sense.
F Tessa Bartels, CPC, CMEC
Our Compliance department revised the guidelines for E/M coding to reflect this change.
The AMA is trying to be consistent in re how to address time. Look at how they count "the first hour" for critical care as an example ... it's 30-74 minutes. They've used the "round up or down" principle for critical care coding (and prolonged service) for quite some time and they have extended that to the typical times for E/M codes.
So for the typical times for E/M:
99203 is listed as 30 minutes
99204 is listed as 45 minutes
The difference in time is 15 minutes ... so once you've gone past the half-way point you round up to the next increment (effectively any time from 38-52 mintues)
That's a more complicated way of putting it than to pick the "typical" time that is closest to the actual time, but it's the same result.
Hope that made sense.
F Tessa Bartels, CPC, CMEC