{"id":13221,"date":"2021-04-08T21:21:25","date_gmt":"2021-04-08T21:21:25","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=13221"},"modified":"2026-05-11T14:12:30","modified_gmt":"2026-05-11T14:12:30","slug":"em-time-based-coding","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/em-time-based-coding\/","title":{"rendered":"E\/M Time-Based Coding"},"content":{"rendered":"

The physician or other qualified healthcare professional are using CPT\u00a0codes from the range 99202-99499<\/strong> which is called Evaluation and management (E\/M)<\/a> codes to represent services offered by physicians.<\/p>\n

These codes are applicable while evaluating and managing patient health. These (E\/M)<\/a> codes have been around for many years still reporting timed-based services is confusing.<\/p>\n

So let\u2019s understand the evolution of coding practices in brief:<\/h2>\n

How coding practices evolved?<\/h3>\n

Before 1992, time is the only an implied factor in the CPT codebook, and E\/M codes had only descriptors which lead to creating confusion for physicians as well as payers.<\/p>\n

For example-<\/strong> Physicians are not sure about determining what E\/M level to report and payers could not assess the clinical documentation and reported E\/M levels objectively.<\/p>\n

This problem is getting attention and requires more clarity on time hence the American Medical Association (AMA) started to include time as a factor. AMA help in the selection of the most appropriate E\/M level for various services such as office and other outpatient services, inpatient services, and consultations.<\/p>\n

Today, various terms that we use for time-based E\/M categories, for example, total time, total visit time, face-to-face and non-face-to-face time, greater than 50 percent, CPT midpoint rule, and rounding are the result of the evolution of codes after 1992.<\/p>\n

However, reporting timed-based services can still be confusing. Here we are trying to simplify time-based rules.<\/p>\n

Definition of Time for Office\/Outpatient E\/M<\/h3>\n

The definitions and roles of time differ depending on the category for E\/M coding hence coders and providers must be aware of these differences to ensure proper documentation and coding.<\/p>\n

Rules for various types of E\/M codes are explained in the time section of the E\/M guidelines, including\u00a0office and outpatient E\/M codes\u00a099202-99205<\/strong> and 99212-99215<\/strong>.<\/p>\n\n\n\n\n\n\n\n
\n

Outpatient E\/M coding<\/strong><\/p>\n

Visit level<\/strong><\/p>\n<\/td>\n

New patient code<\/strong><\/td>\nNew patient time(Min)<\/strong><\/td>\nEstablished patient code<\/strong><\/td>\nEstablished patient time(Min)<\/strong><\/td>\n<\/tr>\n
Level 2<\/td>\n99202<\/td>\n15-29<\/td>\n99212<\/td>\n10-19<\/td>\n<\/tr>\n
Level 3<\/td>\n99203<\/td>\n30-44<\/td>\n99213<\/td>\n20-29<\/td>\n<\/tr>\n
Level 4<\/td>\n99204<\/td>\n45-59<\/td>\n99214<\/td>\n30-39<\/td>\n<\/tr>\n
Level 5<\/td>\n99205<\/td>\n60-74<\/td>\n99215<\/td>\n40-54<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Total time combines the time provider spends on the face-to-face and non-face-to-face encounter on the encounter date. There is a summation of overall time spent over the day with the day starting at 12:01 am and ending at midnight.<\/p>\n

Various tasks like reviewing tests before the patient are present or coordinating care after the patient leaves, the time required for the visit may be included while calculating the total time.<\/p>\n

Moreover, there is a revision in total visit time\u00a0for 2021 to include both face-to-face and non-face-to-face time personally spent by the physician as well as other healthcare professionals on the day of the encounter.<\/p>\n

A most important point to remember here is total time does not include the time spent on activities normally performed by clinical staff.<\/p>\n

Here is the list of activities counted toward a physician\u2019s total time:<\/h4>\n