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Thread: e/m face to face time coding

  1. #1
    Join Date
    Apr 2007

    Default e/m face to face time coding

    AAPC: Back to School
    I have a question about face to face coding. My doctor charged a 99215 and saw the patient for 2 hours he documented that time with the patient is 2 hours in the chart but there is no ROS or Examination type mentioned in the chart. I was not sure if this would justify the use of a 99215.

  2. #2
    Join Date
    Apr 2007
    Fullerton/Buena Park, CA


    You can't code by time. He has to document and show that a 99215 was justified.
    Jennifer DeWitte, CPC, CPC-P, CPB
    Newport Center Surgical
    Coding & Billing Department

  3. #3


    Yes, you can code by time. Refer to your CPT book, pages 6 & 7.

  4. #4
    Join Date
    Apr 2007
    Columbia, MO


    This could justify time based coding but it depends on what is documented and the reason of ra 2 hour encounter can you supply more info? You may have a level 5 with prolonged time or you could have something else plus prolonged time. I think if he did document 2 hours spent then depending on the reason you should use prolonged time codes.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Join Date
    Apr 2007
    North Carolina


    I agree-Per CMS:

    C. Selection Of Level Of Evaluation and Management Service Based On Duration Of Coordination Of Care and/or Counseling.--Advise physicians that when counseling and/or coordination of care dominates (more than 50 percent) the face-to-face physician/patient encounter or the floor time (in the case of inpatient services), time is the key or controlling factor in selecting the level of service. In general, to bill an E/M code, the physician must complete at least 2 out of 3 criteria applicable to the type/level of service provided. However, the physician may document time spent with the patient in conjunction with the medical decision-making involved and a description of the coordination of care or counseling provided. Documentation must be in sufficient detail to support the claim.

    EXAMPLE: A cancer patient has had all preliminary studies completed and a medical decision to implement chemotherapy. At an office visit the physician discusses the treatment options and subsequent lifestyle effects of treatment the patient may encounter or is experiencing. The physician need not complete a history and physical examination in order to select the level of service. The time spent in counseling/coordination of care and medical decision-making will determine the level of service billed.

    The code selection is based on the total time of the face-to-face encounter or floor time, not just the counseling time. The medical record must be documented in sufficient detail to justify the selection of the specific code if time is the basis for selection of the code.

    In the office and other outpatient setting, counseling and/or coordination of care must be provided in the presence of the patient if the time spent providing those services is used to determine the level of service reported. Face-to-face time refers to the time with the physician only. Counseling by other staff is not considered to be part of the face-to-face physician/patient encounter time. Therefore, the time spent by the other staff is not considered in selecting the appropriate level of service. The code used depends upon the physician service provided.

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