APMA News - November/December 2021 - 43

Coding
Table 1 Time ranges for 2021
New patient codes
99202
99203
99204
99205
Total time range
15-29 mins
30-44 mins
45-59 mins
60-74 mins
Established patient codes
99212
99213
99214
99215
Table 2 Prolonged services
Code
99205
99215
Source: 2021 CPT Professional1
Time range
60-74 mins
40-54 mins
To add 99417
75-89 mins
55-69 mins
To add 99417 (x2)
90-104 min
70-84 mins
Total time range
10-19 mins
20-29 mins
30-39 mins
40-54 mins
performing the X-ray service to substantiate an E/M. However,
time spent discussing the results of X-rays may be considered
when choosing a significant and separately identifiable office/
other outpatient E/M level.
If a patient brings in a CD of X-rays taken at another facility,
and you review the images and discuss them with the patient,
you can count the time spent doing so in the calculation of an
E/M. However, if you submit CPT 73630, this code accounts
for the interpretation of the images and that should not be
separately reported.
Evaluation Time Included in a Procedure
The National Physician Fee Schedule Relative Value File3
lists
the pre-procedure, intra-procedure, and post-procedure
percentages of the global package. The pre-evaluation time is
where the decision to perform the procedure is included in
the valuation of the procedure.
Using CPT 11750 (Excision of nail and nail matrix, partial
or complete, [e.g., ingrown or deformed nail] for permanent
removal) as an example, there are 17 minutes attributed to
pre-evaluation. You would have to go well beyond 17
minutes in the evaluation of an ingrown toenail and decision
to perform a procedure to justify a significant and separately
identifiable E/M based on time. But look at CPT 64455
(Injection[s], anesthetic agent and/or steroid, plantar
common digital nerve[s] [e.g., Morton's neuroma]). There
are five minutes in the pre-evaluation column. For CPT
17110, the pre-evaluation time is only three minutes. Only
five minutes of pre-evaluation time are allotted for CPT
11055-57, 11720, and 11721.
Recommendations
Consider documenting the additional time spent discussing
alternative treatment options, etiologies, other medical advice,
etc., that need to be discussed along with whether to perform a
procedure. Your documentation may help substantiate a
significant and separately identifiable E/M service. n
1 CPT 2021 Professional Edition Current Procedural Terminology (CPT®)
is copyright 1966, 1970, 1973, 1977, 1981, 1983-2020 by the American
Medical Association. All rights reserved. CPT is a registered trademark of
the AMA.
2
National Correct Coding Initiative Policy Manual for Medicare Services www.
cms.gov/Medicare/Coding/NationalCorrectCodInitEd
3
www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/
PFS-Relative-Value-Files
APMA News November/December 2021 43

http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/pfs-relative-value-files http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/pfs-relative-value-files

APMA News - November/December 2021

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