Medicare Compliance & Reimbursement - 2018 Issue 6
You Be the Coder: Think Threshold to Understand Typical Time
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Article Overview
This coding Q&A explains the general concept of typical time in evaluation and management visit descriptors and why those times are treated as averages and thresholds rather than exact requirements. It is aimed at coders working with office and outpatient E/M services who want to understand how time, counseling, and coordination of care fit into level selection and documentation. The discussion stays focused on CPT® guidance for established and new patient E/M visit codes and the role of face-to-face time in the encounter.
Why This Topic Matters
Understanding how typical time works is important for accurate E/M level selection, consistent documentation, and avoiding confusion about whether listed times are exact or approximate.
Article Sections
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Question
A reader asks how to interpret the times listed in evaluation and management visit descriptors and whether they are exact or approximate.
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Answer
The response summarizes CPT® guidance on typical time, the role of face-to-face time, and how counseling and coordination of care affect time-based E/M selection. It also notes the importance of documentation and the threshold concept used when selecting a visit level.
What You Will Learn
- How typical time is generally interpreted in E/M visit descriptors
- How face-to-face time fits into time-based E/M selection
- How counseling and coordination of care relate to time-based coding
- Why documentation of counseling and care coordination matters
Who Should Read This
- Medical coders
- Coding students
- Billing and reimbursement staff
- Compliance and documentation reviewers
Codes Discussed
Code Ranges Discussed
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