In what circumstances can a provider select the E/M code based on time?

Selecting an Evaluation and Management (E/M) code based on time is specifically applicable when the majority of the visit involves counseling or coordinating care. According to the E/M guidelines, time can be a key factor in determining the appropriate code, but only under certain conditions.

When counseling or coordinating care makes up more than half of the total time spent in the encounter, that time can be the primary basis for code selection. This means that the focus of the visit is on discussions regarding diagnosis, treatment options, and care coordination, rather than on performing a physical examination or other technical components.

The other options do not meet the specific criteria outlined in the E/M guidelines:

• The duration of the visit itself, like simply lasting more than 30 minutes, does not inherently justify the selection of an E/M code based solely on time.
• While extensive evaluation is pertinent for new patients, it relies more on the complexity of the medical decision-making and the extent of the examination rather than the time spent.
• Choosing a code based on the provider's personal discretion does not align with the structured guidelines that are essential for accurate coding.

Therefore, the accurate understanding and application of when time can be used as a criterion for determining E/M codes are critical for compliance