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E/M time coding question

aamberj

Contributor
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15
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0
I have an Evaluation and Management Coding question that I have seen conflicting advice about.

My question is this: on page 7 of the CPT 2013 Standard Edition Manual, under Select the Appropriate Level of E/M Services Based on the Following, and under #3, they say that "when counseling and/or coordination of care dominates (more than 50%) ..., then time shall be considered the key or controlling factor to qualify for a particular level of E/M services." Do I code based on the total time spent period or the total time in counseling and/or coordination of care spent?

Thanks!
- Ariel
 

mhstrauss

True Blue
Messages
1,241
Location
Baton Rouge
Best answers
0
I have an Evaluation and Management Coding question that I have seen conflicting advice about.

My question is this: on page 7 of the CPT 2013 Standard Edition Manual, under Select the Appropriate Level of E/M Services Based on the Following, and under #3, they say that "when counseling and/or coordination of care dominates (more than 50%) ..., then time shall be considered the key or controlling factor to qualify for a particular level of E/M services." Do I code based on the total time spent period or the total time in counseling and/or coordination of care spent?

Thanks!
- Ariel
You use the total time spent face-to-face with the patient (and/or family) to get the amount of time to base the code on.
 

MikeEnos

Expert
Messages
283
Location
Providence, RI
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Yes, Ariel - Meagan is right. It's the total time. Just make sure the note clearly states:

A) The total length of the encounter (read the E/M guidelines because there is a difference between inpatient and outpatient.)
B) Greater than half of the time was spent in counseling and/or coordination of care (Either literally >50% or they might say 15 of 25 minutes)
C) The content of the discussion must be evident. It doesn't have to be incredibly detailed, but you should be able to see what was discussed (Medication options, side effects, surgery, prognosis, etc)
 
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