E/M on Time and EpiPen® Kit Pay

Base E/M on Time for Counseling/Coordination Only

Question: In case the physician documents: "Time spent in the evaluation of the patient with mostly medical decision making time (two thirds) is 75 min" can you choose the E/M code based on time alone?

Answer: No, you cannot code based on time with just the documentation mentioned above.

Here's why: You must only code for an E/M service based on time alone if no less than 50 percent of the visit was spent on counseling or coordination of care.

How it works: According to CPT manual, you can use the code closest to the documented time. If you are coding by time, choose the closest typical time.

Your documented time must be equal to or goes beyond the average time given to bill that level. For a 35 minute visit spent on a medically necessary counseling-dominated visit, according to CPT you could report medical billing code 99215 (Office or other outpatient visit for the evaluation and management of an established patient … Physicians typically spend 40 minutes face-to-face with the patient and/or family).

Tip: CPT maintains that "this includes time spent with parties who have assumed responsibility for the care of the patient or decision-making, whether or not they are family members (for example, foster parents, person acting in loco parentis, legal guardian."

Keep in mind that although the AMA, via CPT Assistant, directs you to code based on the "closest" time, maximum Medicare payers have always considered the times specified in CPT's code descriptors to represent minimums. Under those regulations, the physician would choose the lower medical billing code (for instance 99214, … physician typically spends 25 minutes face-to-face with the patient and/or family …) except the time was greater than or equal to the higher-level code's needed time (such as 40 minutes for 99215).

Seize EpiPen® Kit Pay With J0171

Question: You used the EpiPen® kit in the office for a patient who went through an allergic reaction to contrast dye. How do you bill for using this kit?

Answer: Use of an EpiPen® denotes an injection of epinephrine. As such, it would be suitable to code its administration using medical coding and billing codes 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) and HCPCS codes J0171 (Injection, adrenalin, epinephrine, 0.1 mg).