I have an ophtholomogist billing E&M codes. He is using the Medicare Eye exam content & Examination Requirements. He has a specialized practice and sees mainly kids with eye diseases. Due to the clients age many of the elements of the exam cannot be performed. Also due to the clients age an extended amount of time is required to perform the exam as the clients can be difficult. The provider is saying due to the amount of time and the clients age and he did all elements of the exam that were age appropriate he can bill the highest level of E&M codes. In his documentation there is no notation or inference of time spent with the client. Is there anything that would allow the provider to bill this level of E&M codes based on age and time spent with the client and would should the documentation reflect if that is the case.