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!!
- 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