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Thread: Billing Based on Time

  1. #1

    Default Billing Based on Time

    AAPC: Back to School
    I have a question on how to code for an E/M service based on time when 50% or more of the time is spent counseling or coordinating care.

    Here is my example:
    A physician sees an established patient and documents a level 3 service based on the 3 key components. At the end of the visit the patient states she is concerned about depression. The physician spends 16 minutes counseling the patient on depression, signs, symptoms and treatment options. Can the physician assign the "typical time" associated with the documented 99213 added to the documented counseling time and select the E/M code based on the Total time of 31 minutes:
    Documented visit 99213= 15 minutes
    Documented counseling time= 16 minutes
    Total Time spent = 31 minues = 99214

    should the physician document the "Actual total visit time" with the patient? (the code would then be selected based on that actual total time; if the counseling time was more than 50% of the actual total time.)

  2. #2


    I was faced with this dilema last week and found good info. in my CPT-Assistant E/M section.

    Out of the 31 minutes, was more than 50% spent on counseling? Yes (16min)
    As long as the provider writes total time spent, how much of that was spent on counseling/coordination of care (more than 50%), and an explanation of the care/counseling, then he or she may bill based on time..

    In your case it would be a 99214 not the 99213, if all of the above criteria is met.

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