09 Aug Would you look at the time…

We discussed some potential changes in E/M visit leveling in last week’s blog. One key point was that the amount of time spent face-to-face with the patient could be used as the key factor in determining a visit’s level of service if CMS decides to adopt its proposed policy.

In the meantime, can you take the length of the patient’s visit into account when deciding whether you’ll be billing a 99213 or 99214? Yes, but with caution.

Under the current guidelines from the CPT Editorial Panel of the AMA, time can only be used to determine the level of service if:

  • The time spent is face-to-face with the patient and/or family.
  • More than 50% of that face-to-face time is spent in counseling or coordinating care.


When documenting for time as the determining factor, details are key:

  • Make sure your note specifies the number of minutes spent face-to-face with the patient.
  • For safety’s sake, it’s recommended to also specify the number of minutes spent counseling and/or coordinating care.
  • For both of the above, take advantage of your EHR system’s time stamps.
  • Explain what the counseling or coordination consisted of, for example: answering questions about treatment plans or extensive discussion of treatment options.


Important: CPT guidelines do not consider administrative tasks completed before or after the visit as part of counseling or coordination, such as documenting in the EHR, filling out forms, completing dictation, refilling prescriptions, or reviewing test results or records.

Sound complicated? Keep in mind the occasions when you spend a lot of time face-to-face with a patient reviewing problems, adjusting medication dosages, and counseling, only to find that you don’t have enough history, exam or medical decision-making elements to support a code that would otherwise be appropriate.

In other words, you’ve spent the time, but your “points” don’t add up. This is when you can make the “greater than 50%” rule work for you.

By documenting appropriately, you can make sure you’re paid for your efforts without having to wrestle with micromanaging the number of elements or body systems in the rest of your progress note.

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