In my opinion, medical necessity should limit the level to what was required to assess and manage the presenting problem(s), regardless of time. (The AAPC's practice exams for the CPC test, do not agree with me, apparently...there's actually a question very similar to this scenario) If the visit length was 40 minutes, and more than 1/2 of that was documented as counseling/CoC, time can be the controlling factor in selecting the level, versus the History, Exam, & MDM scores.
CMS says: "Medical necessity of a service is the overarching criterion for payment in addition to the individual requirements of a CPT code. It would not be medically necessary or appropriate to bill a higher level of evaluation and management service when a lower level of service is warranted. The volume of documentation should not be the primary influence upon which a specific level of service is billed. Documentation should support the level of service reported. The service should be documented during, or as soon as practicable after it is provided in order to maintain an accurate medical record."
I interpret that to mean: You can only bill up to the level that was medically necessary, but you can get there by meeting the code definition's requirements, by either having enough of the key components, or by the amount of time, when applicable. So, if a 99213 is all that's medically necessary, then that's the highest code you can get to, no matter how much documentation you have. But, that's only my opinion...
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