31 May 2016

Time based E&M - Coding Guidelines

            E&M level would be decided basically by 3 key components (History, Physical Examination & Medical decision making). Apart from these 3 key components “Time” is an independent component to decide E&M level when counseling and/or coordination of care dominates the visit.  

How to decide the E&M level based on Time:

            If the physician documents the total time of the visit and mentions that counseling and/or coordination of care dominates the encounter (greater than 50% or over half) then time would be the determining factor of the E&M level.

Documentation to consider Time:


      1. Does total face-to-face visit time is documented in the medical record?  

2. Does the documentation contain the content of counseling and /or Coordination of care?  

      3. Does the documentation clearly state that more than half of the time was spent on counseling or coordination of care?   

If all answers are “YES” then select level based on time. If all answers are “No” then select level based on 3 Key components.

Typical time of E&M codes are given below:

Typical Time
New Patient Visit
Established Patient Visit
5 Min

10 Min
15 Min

20 Min

25 Min

30 Min

40 Min

45 Min

60 Min

Sample Chart:

        A physician sees a patient with lumbar intervertebral disc prolapse and discussing the treatment option and lifestyle modifications along with home exercises to improve the condition. The physicians spend a total face-to-face time of 25 min in the room with the patient. Greater than 50% of the time (15 min) was spending on counseling and coordination of care.

       In the above scenario, all the 3 components to determine Time is met to code the E&M level based on time…. The appropriate established E&M code would be 99214 (25 min)

Total visit time is between 2 typical times:

        When the total visit time is between two typical times, we need to check whether the time spent is closer to the lesser or longer time. If the time spent is closer to the lower typical time report the code with the lower time if the time spent is closer to the higher typical time then report the code with the higher typical time.

For example:

        A physician spends 35 min with an established patient, CPT 99214 (25 min) and CPT 99215 (40 min) the typical time midpoint was passed hence we can assign the CPT 99215.