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Urgent Care E&M coding-New patient

T

TQuack

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Dickinson, TX
If a new patient is seen at an Urgent Care facility that employs ER certified physicians, can they bill procedure 99204 when the patient was only seen face to face for 10 - 15 minutes, or is the coding based strictly on the time spent?
 
The E&M is based on the 3 key components.. however it is hard to justify the complexity of a 99204 with only 10-15 minutes of provider time. Especially since it requires a comprehensive exam and the medical necessity to support a comprehensive exam. It is not impossible but not likely.
 
Time -based coding

CPT defines Time: "Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the the patient and/or family."

"Greater than 50 percent” rule:

For 99204, the total encounter time would have to be at least 45 minutes with more than 50 percent of the visit involved in counseling.

Example:The total encounter time was 45 minutes, of which 25 minutes (greater than 50%) were spent in... activities.

Suggestion: To make a logic guess, without viewing the document- 10-15 mins face-to-face will not suffice for 99204.

rsmallcanyon, RHIT, CPC
 
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