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Thread: E/M service based on time

  1. #1
    Join Date
    Apr 2007

    Default E/M service based on time

    AAPC: Back to School
    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?

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    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.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Join Date
    Apr 2007
    Milwaukee WI

    Default 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

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