As we know, there are many Current Procedural Terminology (CPT®) codes within the Evaluation and Management Services (E/M) section of the CPT book that allow for the utilization of time as a basis for code selection when counseling and/or coordination of care dominates the visit.1 There are several guidelines that must be followed when coding services based on this principal; one good resource is the CMS 1995 & 1997 Documentation Guidelines for E/M Services.2 Per CPT, for time measurement, a unit of time is attained when the halfway point has passed.3

For example, 99214, an established office visit, typically includes 25 minutes of face-to-face time with the patient. The documentation states that a total of 20 minutes was spent with the patient and 11 of those minutes were spent in counseling and coordination of care. Using our time guidelines, we know that the half point was reached and we also have documentation showing greater than 50% was spent in counseling and coordination of care. Therefore, the documentation supports a 99214 based on time.

Keep in mind that when codes are ranked in typical times (for example and 99213 is 15 minutes at 99214 is 20 minutes and 99215 is 25 minutes), the code with the typical time closest to the actual time is used.

1 2015 CPT Professional Edition Manual, American Medical Association, page xv.
2 CMS 1995 & 1997 Documentation Guidelines for E/M Services (pg 15 & 51 respectively).
3 2015 CPT Professional Edition Manual, American Medical Association, page xv.

Author - Female

About the author

Lori Johnson, CPC, CPMA of Compliance—Academic, Multi-specialty and Office-based Medicine, McKesson Business Performance Services.