Health Information Management

Tip: Count time correctly under new CPT guidelines

APCs Insider, February 25, 2011

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The AMA included a new subhead (Time) and guidelines for reporting time in the 2011 CPT® Manual. 

The AMA changed the instruction to:

• Create general rules for codes that do not specify their own time rules
• Define rules for services that start on one calendar date and continue on another
• Restate that time is counted as face-to-face unless otherwise specified

Only report time units when the midpoint has been passed. For example, at least 31 minutes must pass in order to report a code with a one-hour unit of time in its description.

When using time to select an E/M code, pick the code with the closest typical time, even if it is less than the actual time spent on the encounter. In order to report an E/M code based on time, make sure to follow the time rule in the E/M section. Specifically, the provider must spend more than 50% of the visit performing counseling and coordination of care.

Remember that you may not count time twice. Review the services in which time is already a factor and be certain that you don’t count that time twice by relying on it to report another code

This tip is adapted from “2011 CPT changes feature new time guidelines, subsequent observation care codes” in the February issue of Briefings on APCs.



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