Does this help?
"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."
This implies that time is the controlling factor...
CPT Assistant 1991:
"The content of the service is used to select the appropriate level of E/M service. In the case where counseling and/or coordination of care dominates (more than 50%) the face-to-face physician/patient encounter, then time is considered the key or controlling factor. The extent of counseling and/or coordination of care must be documented in the medical record."
CPT Assist 1992:
.......The exception to selecting a code based on which two or three key components were met or exceeded, is when counseling and/or coordination of care dominates (more than 50%) the face-to-face physician/ patient encounter; then time is considered the key or controlling factor to qualify for a particular level of E/M services. The code selected for this encounter is selected based on the total time of the face-to-face physician/patient encounter. The extent of counseling and/or coordination of care must be documented in the medical record.
The total time Dr. "A" spent with Mrs. Smith was forty minutes; thirty minutes of this time were spent counseling. Code 99215 would be reported, based on the total time spent face-to-face by Dr. "A" with Mrs. Smith. Dr. "A's" documentation should indicate the extent of the counseling he provided at this encounter. (Note: Doctor "A" did not perform two of the three key components required to report code 99215. Because counseling dominated the face-to-face physician/patient encounter, time is considered the controlling factor to qualify for this level of service. Code 99215 was selected because the total time spent with Mrs. Smith (an established patient seen in his office) was 40 minutes.)
- ICD-10 Trainings
- Comprehensive Courses
- CPC (Certified Professional Coder)
- COC (Certified Outpatient Coder)
- CIC (Certified Inpatient Coder) NEW!
- CRC (Certified Risk Adjustment Coder) NEW!
- CPB (Certified Professional Biller)
- CPMA (Certified Professional Medical Auditor)
- CDEO (Certified Documentation Expert – Outpatient) NEW!
- CPPM (Certified Physician Practice Manager)
- CPCO (Certified Professional Compliance Officer)
- VIEW ALL CERTIFICATIONS
Coding / Billing Solutions
- Audit / Compliance Solutions
Job Experience / Apprentice Removal
News / Discussion
- Other Resources
- Book Store
- Log In / Join