{"id":8677,"date":"2019-04-29T08:35:49","date_gmt":"2019-04-29T03:05:49","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=8677"},"modified":"2025-06-02T07:37:15","modified_gmt":"2025-06-02T07:37:15","slug":"time-based-billing-for-cpt-evaluation-and-management","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/time-based-billing-for-cpt-evaluation-and-management\/","title":{"rendered":"Time-Based Billing for CPT Evaluation and Management"},"content":{"rendered":"

Within the guidelines of the CPT code book, CPT has stated; \u201cWhen counseling and\/or coordination of care dominates (more than 50%) the physician\/patient and\/or family encounter (face-to-face time in the office or other outpatient setting or floor\/unit time in the hospital or nursing facility), then time may be considered the key or controlling factor to qualify for a particular level of E\/M services.<\/p>\n

What this means to our physicians<\/a> and providers, is that time alone can be used to select a level of care, and bill for our services regardless of the clinical documentation of history, exam and medical decision making.<\/p>\n

If these physicians and providers utilize the option of documentation of \u201cTime\u201d in the clinical notes, they still have to document the care given, but it can be noted that they spent \u201cXX amount of time\u201d at the bedside and\/or on the unit in care of the patient and of that 50% of this time was spent in counseling, and coordination of care of \u201cXXX diagnosis, testing, etc.\u201d<\/p>\n

Time-based clinical documentation does need to be very specific,\u00a0 The face-to-face time spent in an outpatient or office type setting includes not only the time the provider spent counseling and coordination of the patients care but has to be rendered face to face with the patient.\u00a0\u00a0 Any pre or post time spent (when patient and provider are not face-to-face) cannot be included in the time component described in the CPT E&M codes.<\/p>\n

From a revenue and denial standpoint, it is frustrating to have an auditor or insurance carrier review the clinical chart and down code the admission from a 99222\/223 to a low-level admission 99221 due to skimpy history, exam, or medical decision notations.<\/p>\n