Using Time to Select a Code

Use these rules when billing for codes that use the 1995/1997 guidelines. In 2021, this does not include codes 99202–99215.

What codes continue to use 1995/1997 rules?

• Hospital services, 99221–99233
• Consultations, 99241–99255
• Observation care, 99218-99220, 99224–99226,
• Observation or inpatient hospital care 99234-99236
• Home visits, 99341–99350
• Domiciliary care, 99324–99337

Documentation requirements | Using time to select the code

• For time based codes, document time in the medical record, not just the billing record
• Counseling/coordination of care must “dominate” the visit, that is, must be more than 50% of the encounter
• For outpatient consults, home visits and domiciliary care, more than 50% of the face-to-face time must be in counseling or care coordination; for facility visits, more than 50% of the unit time

Counseling is discussion with patient and/or family regarding:

• Diagnostic results, impressions, recommended diagnostic studies
• Prognosis
• Risks & benefits of management
• Instructions for management
• Importance of compliance
• Risk factor reduction
• Patient and family education

Key points when using time to select a CPT^® code

• Document time in the medical record when time is used to select the service.
• For E/M services in which time is the determining factor, document the total time of the visit, the fact that more than 50% was spend in counseling, and the nature of the counseling. Select your level of service based on the total time.

What to document for codes

• Total time for the visit (provider, not staff time)
• Statement that more than 50% of the visit was counseling or coordination of care
• Description of the nature of the counseling

Remember, codes 99202–99215 no longer follow this guidelines.

Citations
Internet Only Manual, Medicare Claims Processing Manual, Pub. 100-04, Chapter 12, Section 30.6.15.1

Prolonged Services

Starting January 1, 2021, 99354 and 99355 may not be reported with codes 99202–99215.

CPT® Code	Descriptor
+ 99354	Prolonged physician service in the office or other outpatient setting requiring direct (face-to-face) patient contact beyond the usual service; first hour (List separately in addition to code for office or other outpatient Evaluation and Management service) Use 99354 in conjunction with 90837, 90847,  99241-99245, 99324-99337, 99341-99350, 99483
+ 99355	each additional 30 minutes (List separately in addition to code for prolonged physician service Use 99355 in conjunction with 99354
+ 99356	Prolonged physician service in the inpatient setting, requiring unit/floor time beyond the usual service; first hour (List separately in addition to code for inpatient Evaluation and Management service) Use 99356 in conjunction with 90837, 90847, 99218-99220, 99221–99223, 99224-99226, 99231–99233, 99234-99236,  99251-99255, 99304–99310
+ 99357	each additional 30 minutes (List separately in addition to code for prolonged physician service) Use 99357 in conjunction with 99356

Bill an E/M and prolonged or just an E/M based on time?

• If the visit is 100% counseling, bill an E/M based on time. Add prolonged services only when the threshold time for the highest level of code plus 30 minutes is met
• If the visit has history, exam and MDM components, bill an E/M based on the level of service, and add a prolonged code if the total time is 30 minutes more than the typical time for the code.

Download the Definitive Guide to Using Time to use as a handy quick reference.

[/mepr-show]

Login to read the rest of this article

---

Don’t have a login? Become a member, or learn more about the benefits of membership by clicking on the link below.