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November 6, 2019
Evaluation and Management – Time
When using time to support a level of service under Evaluation and Management, total time spent face to face with the patient must be documented along with documentation of what was included in the counseling and/or coordination of care. Simply stating “45 minutes spent with more than 50% being counseling and coordinating care” is not sufficient to support a level 5 established patient visit if the documentation submitted does not otherwise support the service. Per CPT “the extent of counseling and/or coordination of care must be documented in the medical record”.
Rule of 8 and timed modalities – when more than 1 timed modality or therapeutic procedure is utilized during the same encounter, the total minutes spent is combined to determine the # of timed units that may be billed. For example: 97110 – 8 minutes + 97140 – 9 minutes. Total time is 17 minutes. Using the table below, only 1 unit of service is billable:
Time spent on untimed codes such as 97010 or 97014 would not be included in the total calculation as they are not designated as timed modalities although they would count toward the 8 units allowed per visit.
Remember: A total of 8 units of active/passive therapeutic procedures per visit with these exceptions:
|8 – 22 minutes
|23 – 37 minutes
|38 – 52 minutes
|53 – 67 minutes
- If active/passive therapeutic procedures are utilized:
- only 2 units may be a passive modality per visit.
- If only passive modalities and/or passive therapeutic procedures are being utilized, only 4 units may be billed per visit.