AAPC - Back to school
Results 1 to 3 of 3

Thread: 21 minute est pt EM visit based in time

  1. #1

    Default 21 minute est pt EM visit based in time

    AAPC: Back to School
    If all the criteria is met for billing based on time and the total visit was 21 minutes, would you bill a 99213 or a 99214?
    CPT says 99213 is typically 15 min and a 99214 typically 25 min. So what if you are in between? Along with an answer, I need resources to back up the statements, so I can take to other people at my job. Please provide me direct links to info stating how to handle this. Thanks in advance!

  2. #2


    In the Cpt manual guidelines under "Select the Appropriate Level of E/M Services Based on the Following" in paragraph #3 it states:

    "When counseling and/or coordination of care dominates (more than 50%) the physician/patient and/or family encounter (face to face time in the office or other outpatient setting or floor/unit time in the hospital or nursing facility), then time shall be considered the key or controlling factor to qualify for a particular level of E/M services. This includes time spent with parties who have assumed responsibility for the care of the patient or decision making whether or not they are family members (eg. foster parents, person acting in loco parentis, legal guardian). The extent of counseling and/or coordination of care must be documented."

    So, if the physician spent even one minute over the E/M time specified, the next highest should be used. Example (99213 = 15 minutes face to face time with physician, then the physician face to face time is 16 minutes or more within this code family, the next highest E/M code will default, but the necessity of the time spent has to be documented.

    Hope this helps...Happy Thanksgiving!!

  3. #3
    Join Date
    Apr 2007
    Concord, NC or Rochester, NY


    When using time for the key component, you have to meet the average time of the visit in order to use that code. Therefore in your situation, you would code a 99213. In order to code a 99214, 25 minutes of total time.

Similar Threads

  1. Office visit based on time
    By eharn in forum E/M
    Replies: 4
    Last Post: 09-11-2014, 10:56 PM
  2. Level 5 EP visit based on time
    By ollielooya in forum E/M
    Replies: 2
    Last Post: 01-18-2013, 04:20 PM
  3. Visit based on time
    By lgrennan in forum Pediatrics
    Replies: 4
    Last Post: 05-23-2010, 10:22 PM
  4. Initial visit based on time only ???
    By Orthocoderpgu in forum E/M
    Replies: 3
    Last Post: 10-19-2009, 07:03 AM
  5. Time Based Visit
    By deyoung in forum E/M
    Replies: 4
    Last Post: 03-04-2008, 02:16 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.