Jen Godreau, BA, CPC, CPEDC

Content Director
Inhealthcare’s Supercoder
jenniferg@supercoder.com
Is This How
You’re
Protecting
Your Time-
Based Pay?
http://obs.kg/video/159/B
eatles-Cartoon--Money
Spot Problem in Chart
Entry
An 8-year-old boy seen for ADHD (chief complaint)
FU (HPI-duration) visit. He has been on stimulant
medication (HPI-modifying factor) for one month
(HPI-duration) but is not doing well (HPI-quality).
He is still having problems attending school (social
history-education) and with off-the-wall behavior
at home (HPI-severity). His parents have not noted
problems with appetite (ROS-constitutional) or
sleep issues (ROS-neurological or respiratory-not
both). Physical examination consists of a brief
neurological examination (can’t give credit here as
there are no details).
Chart Entry (Cont.)
Extensive counseling is done for school and
behavioral issues, his diagnosis of ADHD and
treatment options (counseling description). His
stimulant dosage is increased (prescription drug
management-table of risk-moderate) (MDM risk: 2
pts) and FU planned in one month. Total face-to-
face time is 25 minutes. (can’t use this
without
knowing how
much of that
time was spent
counseling).
Documentation
Requirements
To code based on time, the physician
must document:
the total time spent with the patient
that more than 50 percent of the face-to-
face time the physician spent with the
patient/and or family is
counseling/coordination of care
a description or summary of the
counseling/ coordination of care.
 No
Chart Entry Problem %
If included
Rule: documentatio
CPT lets you select an office visit n
code based on time only when requirements,
the physician spends more visit would
than 50 percent of the face- support
to-face time with the patient
and/or family member on 99214
counseling and/or Typical
coordination of care time:
25
minutes
Protect Your Pay
If documentation does not
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 HEM.
$33 per 99214
down coded to
99213
 History-Detailed:
 HPI-quality, severity, duration,
modifying factors-EXTENDED
 ROS-Constitutional, Neuro (or
respiratory-not both)
 PFSH-Social
 Exam-NONE
 MDM-Low:
 Est. Problem worsening-2 pts
 Data-NONE
 Risk-Moderate
 CODE: 99213
Easy Ways to Document
Time
Statements such as “I spent
[counseling/coordination of care] minutes of
[total] minutes on this service for [topic]
visit.”
Shorthand abbreviations to represent total
counseling/ coordination of care time and total
time such as TC/TT: Time Counseling or
Coordinating care/Total time.
45T/30C
Code Requirements
Descriptor must include time
Physician or nonphysician practitioner
depending on law and scope of practice must
provide counseling
Allowed providers: MD, ARNP, PA

Medicare will not cover services

in which patient is not present
Counting Allowed
Minutes
Outpatient Inpatient
Outpatient time is face-  Inpatient time is floor time.
to-face time.  When tallying hospital time,
You can only count time you can include these
services:
the physician spends
 looking at records
directly with the patient
 talking to nurses
and/or family (Medicare
 documenting the visit
requires patient present).
 writing orders in the chart
 making related telephone
calls.
Stay Compliant
Method 1: Code Visit Using Time
Allotments
Medicare considers times to be minimums.
Method 2: Treat Times as Averages
Documented time must equal or exceed the
‘average’ time given to bill that level.
Times as Averages
 “In selecting time, the physician must have spent a time closest to the code
selected,” states CPT Assistant Aug. 2004.
 Following CPT Assistant’s closest time code rule, time breakdowns for office visits
include:

Code For this level, CPT descriptor
indicates physicians typically
spend this many minutes face-to-
face with the patient and/or family
CPT Assistant indicates to use
when counseling/coordination of
care dominates face-to-face
office time totaling this many
minutes

99212 10 10-12.5

99213 15 12.6-20.5
99214 25 20.6-32.5

99215 40 32.6 or more

Compare Both Methods
“I spent 35 minutes with patient, 20 minutes
of which was for counseling regarding
weight management, helping to formulate
a diet and exercise plan.”
Method 2:
Method 1:
Select 99215 when time
When considering the time
spent is 33 minutes or
allocations as thresholds,
longer (AAP News July
example supports 99214.
2008).
Thank You!
Contact:
 E-mail:
Jenniferg@supercoder.com

Other resources:
 Forums:
 Supercoder.com/forum
 AAPC.com
 Askleslie.com
 Facebook.com/supercoderpa
ge
 SupercoderAlerts:
 Family Practice
 Internal Medicine
Questions
Can you code based on time with new
patients?
Does Medicaid follow Medicare rules?
$197 Value!