E/M services: total-visit time versus counseling time
Q
When a physician spends more than 50% of an in-office visit counseling and/or coordinating care, we select the appropriate E/M services code based on the amount of time spent counseling, not the total-visit time. How are the 2 different? And does the latter include only physician/patient interactions or can it include the time spent with nurses, medical assistants, etc.?
A
Think of the criteria for selecting an E/M code based on time as consisting of 2 factors. First, the counseling time must represent more than 50% of the face-to-face time. Second, if the first condition is met, select the code based on the total face-to-face time documented in the patient’s medical record. This total-visit time is reflected in the nomenclature of each E/M code as follows: “physicians typically spend XX minutes face-to-face with the patient and/or family.”
