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Managing Coding Quality
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Expertise in Evaluation and Management Coding
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When Does TIME Prevail-Understanding the E/M Time Factor
Time - Needed Criteria
If the physician document total time and suggests that counseling or coordinating care dominates more than 50% of the encounter, time may determine the level of service. Documentation may refer to: Prognosis, differential diagnosis, risks, benefits of treatment, instructions, compliance, risk reduction or discussion with another health care provider.
If all answers are YES to the following queries, you may select a level of service based on time:
- Does the documentation reveal total time? (face to face in an outpatient setting)
- Does the documentation describe the content of counseling or coordination of care?
- Does the documentation reveal that more than half the time was counseling or coordinating care?
Levels = Time
| Level |
Time |
Level |
Time |
| 99201 new out pt |
10 min |
99211 est. out pt |
5 min |
| 99202 |
20 min |
99212 |
10 min |
| 99203 |
30 min |
99213 |
15 min |
| 99204 |
45 min |
99214 |
25 min |
| 99205 |
60 min |
99215 |
40 min |
| 99241 out pt consult |
15 min |
99251 in pt consult |
20 min |
| 99242 |
30 min |
99252 |
40 min |
| 99243 |
40 min |
99253 |
55 min |
| 99244 |
60 min |
99254 |
80 min |
| 99245 |
80 min |
99255 |
110 min |
| Code |
Description |
Time |
| 99302 |
Initial nursing facility care, per day, for the evaluation and management of a patient; requiring detailed or comprehensive history and exam and straightforward or low-complexity medical decision making (MDM) |
25 min |
| 99305 |
...;comprehensive history and exam; moderate complexity MDM |
35 min |
| 99036 |
...;comprehensive history and exam; high complexity MDM |
44 min |
| 99307 |
Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: problem focused interval history, problem focused exam, straightforward MDM |
10 min |
| 99308 |
...;expanded problem focused interval history, expanded problem focused exam, low-complexity MDM |
15 min |
| 99309 |
...;detailed interval history, detailed exam, moderate complexity MDM |
25 min |
| 99310 |
...;comprehensive interval history, comprehensive exam, high complexity MDM |
35 min |
| 99318 |
Evaluation and management of a patient involving an annual nursing facility assessment, which requires a detailed interval history, comprehensive exam and low moderate complexity MDM |
30 min |
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