Coding Time-Based Services

The previous installment of “Spotlight on CPT” presented information regarding the determination of “time” for applicable codes. The CPT classification has time as a basis for many codes such as:

E&M codes

Administration of hydration, infusion, and chemotherapy codes

Telemedicine

Physical Medicine and Rehabilitation

Psychotherapy

This is by no means a comprehensive list but does give a coding professional an idea of where many time-based codes are found.

There are certain standards that are applicable to all time-based codes. These include:

Time is determined based on face-to-face time with the patient.

The mid-point of a unit of time must be passed in order to assign the time unit.

Example: If the time unit is 15 minutes-8 minutes must pass to capture the 15 minute unit.

Some codes with time-based criteria for assignment are governed by specific guideline instructions, parenthetical notes, or code descriptions. These include some E&M codes. There is a time threshold associated with those codes, which is based on total time on the encounter date. The concept of the mid-point would not apply for code assignment in those categories. For example:

98002 Synchronous audio-video visit for the evaluation and management of a new patient,

which requires a medically appropriate history and/or examination and moderate medical decision making.

When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.

For this example, it would be inappropriate to assign 98002 if only 25 minutes of total time was achieved, even though this is more than halfway to 45 minutes. In addition, if 43 minutes of total time was documented, it is still inappropriate to assign 98002 since the entire 45 minutes was not met. The coding professional must assign the code 98001 for total time of 30 minutes met or exceeded.

If another service happens to be performed along with a time-based service, coding professionals should exclude the time for the other service from the calculation of the time-based service code.

Prolonged services code assignment (99417, 99418) requires the full 15 minutes of time in order to report any unit.

Additional information for coding time-based services can be found in the E&M Services Guidelines section of the CPT manual.

Now, light has been shed on coding time-based services.

About the Author

Dianna Foley, RHIA, CCS, CDIP, CHPS, has 25 years of HIM experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA. Dianna’s an AHIMA-approved ICD-10-CM/PCS trainer, an AHIMA-published author, a participant in AHIMA credential item writing and exam development, and served on the AHIMA Nominating Committee. Dianna has held various HIM positions and is now an independent coding consultant. She previously served as a program director for Medical Coding and HIT. She presents on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator.