Time-based coding is one of the least-understood elements in Evaluation and Management Service coding. Unlike other E/M patient encounters which use history, components, physical practice for coding, time-based coding uses “time” as the key component. In CPT® manual, time is listed merely as a guideline, whereas, a variety of codes are listed by CPT® that are time-dependent and use codes for prolonged services. This has created confusion regarding the importance of time, specifically when you’re coding long office and inpatient visits. The requirements of coding and documenting on the basis of time varies from practice to practice, for instance, office visits, critical care, chronic care management, all have different requirements. Practices either loses out by not billing based on time when they could – or they incur audit risks because they do not document the time appropriately.
According to CPT® guidelines, “When E/M codes are ranked in sequential typical times and the actual time is between two typical times, the code with the typical time closest to the actual time is used.” For instance, suppose a level 3 established patient outpatient visit (99213) has a reference time of 15 minutes, and a level 4 service (99214) has a reference time of 25 minutes. When reporting a time-based evaluation and management service lasting 19 minutes, report 99213 because it has the closest reference time.
Prolonged Services
In CPT® 2016, two new time-based, add-on E/M codes were introduced to describe prolonged clinical staff services provided with direct patient contact.
Code +99415
Prolonged clinical staff service (the service beyond the typical service time) during an E/M service in the office or outpatient setting, direct patient contact with physician supervision; first hour (List separately in addition to code for outpatient Evaluation and Management service)
Code +99416 each additional 30 minutes (List separately in addition to code for prolonged service)
The services must be directly supervised by the physician or qualified healthcare professional, which means that the physician or nonphysician practitioner must be present on the same campus where the services are being furnished.
Note: The time counted toward +99415 and +99416 does not have to be continuous; though, time spent by clinical staff performing other, separately reported services does not count toward prolonged services time. Also, facilities may not report +99415 and +99416.
To help you appropriately document time-based coding and ensure correct reimbursement, our expert speaker Kim Huey will present an audio session on Coding and Documentation for Time Based CPT® Services. She will throw light on the CPT® codes that can be billed based on time and share tips on appropriate documentation. Find out whether time only counted when face-to-face or does prep time count and more questions like that in the session.
