1. User id : 21047 Posted 1 year ago #
   

   I know that cms and cpt state that when choosing to code based on time that the counseling must exceed 50% of the visit.
   Is it defined anywhere that it must exceed 50% of the total visit time, or exceed 50% of the time associated with the code selected, I have read both as suggestions by others, but woud like CPT or CMS statement on the matter.
   Examples would be typical time for a 99214 is 25 minutes.
   documentation states 15 minutes of a 30 minute visit spent...etc.
   How do I tell my physician that had he spent 5 minutes less with the patient then he would qualify for a 99214, otherwise he is now only going to get a 99212 (based on key elements) since 15 is not MORE than half of 30???? Especially when the code selection he is interested in acheiving is a 99214 and 15 minutes is MORE THAN half of 25??
   Any supporting documentation in this matter would be appreciated.
   Thanks
   Ang

2. SuperCoder Posted 1 year ago #
   

   If documentation states "15 minutes of a 30 minute visit spent", you should not code it based on Time.
   http://www.dailymotion.com/video/xcds83_time-based-em-coding_school
   ...
   You should protect your pay by following this guideline:
   If documentation doesn't specify that the encounter has met the "more than 50 percent counseling requirement"
   - DO NOT use Time as the controlling factor to select the level of E/M service.
   - DO Code based on History, Exam and MDM.
   ...

   On the other hand, "in selecting time, the physician must have spent a time closest to the code selected," states CPT Assistant Aug.2004.
   CPT Assistant indicates to use when couseling/coordination of care dominates face-to-face office time totalling this many minutes: [http://www.dailymotion.com/video/xcds83_time-based-em-coding_school]
   99212: 10-12.5
   99213: 12.6-20.5
   99214: 20.6-32.5
   99215: 32.6 or more
   So, while calculating total time, you can follow above threshold time break-ups, but in the context of more than 50% of the total visit time, this rule has to be strictly followed.

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