When coding office or outpatient visits based on time, it is essential to consider the total minutes a physician or qualified healthcare professional spends on various activities, including time spent updating the patient’s medical record. These activities must take place on the same calendar date as the face-to-face encounter.
Key Points about Time-Based Coding:
- Time-based coding applies to nine specific activities conducted on the date of the face-to-face encounter.
- Time-based coding does not apply to CPT code 99211, which pertains to visits that may not require a physician or qualified healthcare professional’s presence.
- Practices should follow payer-specific guidelines for documenting time accurately.
- Prolonged service codes must be reported when applicable. These include:
- CPT Code 99417: Prolonged outpatient evaluation and management services beyond the required time for the primary service, reported in 15-minute increments.
- HCPCS Code G2212: Prolonged office or outpatient evaluation and management services beyond the maximum required time for the primary service, also reported in 15-minute increments.
- Time must be counted on the same day as the visit.
A Comprehensive Approach to Time-Based Coding:
Clinicians should consider both face-to-face and non-face-to-face time when coding visits based on time. The 2023 CPT manual clarifies that the total time for coding includes both face-to-face and non-face-to-face time spent by the physician or other qualified healthcare professional on the same calendar date as the encounter. This includes activities requiring the healthcare professional’s direct involvement but excludes tasks typically performed by clinical staff. Importantly, time spent on separate services should not be counted.
For example, any time spent reviewing the patient’s chart the day before the visit or completing documentation on subsequent days does not count toward the total time for the visit, as these activities must occur on the same calendar day.
Activities That Count Toward Time-Based Coding:
Providers should be aware of the activities that qualify for time-based coding to ensure accurate documentation. These activities must occur on the day of the face-to-face visit. The following actions count toward the total time:
- Preparation for the patient visit: Reviewing the patient’s history, test results, or chart before the encounter.
- Obtaining or reviewing a separately obtained history.
- Performing a medically appropriate examination or evaluation.
- Counseling and educating the patient, family member, or caregiver: This always counts, even if the counseling occurs after the face-to-face encounter on the same day.
- Ordering medications, tests, or procedures.
- Documenting clinical information: Ensure that the medical record is updated on the date of the encounter.
- Other activities not reported separately: Including referrals and communication with other healthcare professionals, independent interpretation of results, and care coordination.
Activities That Do Not Count Toward Time-Based Coding:
Certain activities cannot be included in the time calculation:
- Time spent on separately reported services.
- Travel time, including commuting or work-related travel.
- General education unrelated to managing the patient’s specific care (e.g., general advice about sunscreen application does not count).
Tracking and Reporting Time:
To ensure accurate coding, healthcare providers should maintain a list of qualifying activities and track the time spent on each. A cheat sheet with time ranges for each code is beneficial for those responsible for selecting codes. It is important to note that time-based coding does not follow the standard time rule (such as meeting half of the stated time requirement for a code). Instead, the total time spent on activities directly related to the visit determines the appropriate code.
Example of Time Calculation:
Consider a physician who documents the following activities on the day of a patient’s visit:
- Communicating with the patient’s primary care provider about the patient’s condition.
- Reviewing the patient’s history.
- Performing a physical examination.
- Discussing treatment options with the patient.
- Writing prescriptions.
- Ordering diagnostic tests.
- Updating the patient’s medical record.
If the physician spends a total of 34 minutes performing these activities, the appropriate CPT code would be 99203 for a new patient visit or 99214 for an established patient visit, as both codes require a minimum of 30 minutes for coding based on time.
Frequently Asked Questions (FAQ)
- Can time spent on activities before or after the visit be counted? No, time-based coding requires that activities be performed on the same calendar day as the face-to-face encounter. Pre- or post-visit activities cannot be included in the total time.
- What is the difference between CPT code 99211 and other time-based codes? CPT code 99211 applies to visits that may not require the presence of a physician or qualified healthcare professional, while time-based coding applies to services where the physician or healthcare professional’s time is directly involved in patient care on the same day.
- Do clinical staff members’ time count toward time-based coding? No, time-based coding only counts the time spent by the physician or other qualified healthcare professionals. Time spent by clinical staff does not count.
- Is travel time considered when calculating time for an office visit? No, travel time, including commuting, is not included in time-based coding for office visits.
- How do I report prolonged services? Prolonged services are reported using either CPT code 99417 or HCPCS code G2212 when the time spent on an outpatient visit exceeds the primary service’s required time. This is reported in additional 15-minute increments beyond the initial service time.
- What if the activities required to meet the time threshold for a code are not performed during the visit? If certain activities that count toward time are not performed during the visit, the total time may fall short of the requirement for a higher-level code. Ensure that all qualifying activities are considered when calculating total time.