Coding Alert
Understanding the Importance of Reporting Time Based Services

Many codes are available to report services based on time. Per CPT guidelines, the following standards apply to time measurements, unless there are –

  • Code or code-range-specific instructions in guidelines,
  • ​Parenthetical instructions, or
  • Code descriptors to the contrary

Time is the face-to-face time with the patient. Phrases such as “interpretation and report” in the code descriptor are not intended to indicate that report writing is part of the reported time. A unit of time is attained when the mid-point is passed. For example, an hour is attained when 31 minutes have elapsed (more than midway between zero and sixty minutes). A second hour is attained when a total of 91 minutes have elapsed. When codes are ranked in sequential typical times and the actual time is between typical times, the code with the typical time closest to the actual time is used.

A few reminders when coding services based on time –

  1. When the Evaluation and Management New and Established (E&M) visits (99201-99215) involves more than 50 percent counseling or coordinating care, time can then determine the level of care. For example, if a 30-minute office visit with an established patient involved more than 15 minutes of counseling and coordination of care, the service could be coded with CPT 99213. Documentation must be complete and support the medical necessity for the service. The documentation should clearly state the total amount of time of the visit in addition to the counseling and coordination time.
  2. Prolonged Services with Direct Patient Contact (99354-99357). These codes are used for patient services that require more time than what are typical prolonged services in addition to the appropriate E&M code. When calculating the number of minutes spent in prolonged service, do not include the average time allotted by CPT for the E&M code. Count only the minutes spent beyond the typical service.

Coding Alert Icon

Don't miss this article –

2017 CPT Coding Updates

Time-Based Services
  1. When coding on the basis of time in the outpatient setting, count only face-to-face time with the patient or family. This face-to-face time includes not only the time spent counseling but also the time associated with history, exam and / or medical decision making that you perform. The time spent reviewing records, talking with other providers and documenting the encounter without the patient of family present cannot be considered.
  2. For inpatient and nursing home settings, time is measured using the face-to-face time with the patient as well as other time spent on the unit or floor related to the care of the patient. The unit / floor time might include discussions with nursing staff or therapists, calls to other physicians or providers and tasks such as reviewing or documenting in the medical record.
  3. When reporting service units for procedures that are not defined by a specific timeframe, the service is reported with one (1) unit of service. Several CPT codes used for therapy modalities, procedures, tests and measurements specify that the direct time spent in patient contact is 15 minutes. Providers report procedure codes for services delivered on a single calendar day using CPT codes and the appropriate number of 15 minute units of service. For example, if the therapeutic service code (97532 defined in 15 minutes) is provided for a total of one hour, the provider would report 97532 with four (4) units of service.
  4. The time threshold associated with the new 2017 moderate sedation codes (99151-99157) is a minimum of 10 minutes. Moderate sedation less than 10 minutes should not be reported.

Please refer to your current CPT coding resources to obtain a complete understanding of the guidelines associated with reporting time based services.

These are just some of the changes we face in 201​7. Fortunately, help is available – if you have coding questions, contact your Provider Coordinator. We’re happy to help.


View List of Spring 201​7 Unity Communicator Articles