E/M Level when time and MDM are documented

Article

Your coding questions answered.

Q: A physician documents 20 minutes of time, which supports E/M code 99213; however, the medical decision making (MDM) involved supports a moderate level code (99214). Can we bill the higher-level code based on the MDM?It’s my understanding that the guidelines state to choose either total time on the date of the encounter or MDM.

A: Yes, it would be appropriate to report code 99214 if the MDM supports it. The code selection should be based on the most appropriate and relevant elements for a given patient encounter. The choice to select a code level based on time or MDM will vary depending on the presenting concerns of the patient, the time spent, and the complexity of the encounter. The CPT E/M guidelines for office or other outpatient visits do not designate the advantages of either MDM or time. Instead, the code-level selection and the determination to use either time or MDM should reflect the time and level of services provided for the patient’s presenting problem(s). Therefore, the code-level selection depends entirely on the nature of the visit.If the medical necessity of 99214 is supported by the MDM, it would be appropriate to bill the higher-level code.

Renee Dowling is a compliance auditor at Sansum Clinic, LLC, in Santa Barbara, California.

Newsletter

Optimize your practice with the Physicians Practice newsletter, offering management pearls, leadership tips, and business strategies tailored for practice administrators and physicians of any specialty.

Recent Videos
P2 Management Minute: Keeping practice staff happy
P2 Management Minute: Improving patient satisfaction
P2 Management Minute: Measuring practice staff performance
P2 Management Minute: Making your practice welcoming to patients
P2 Management Minute: Reducing malpractice risk
P2 Management Minute: Summer staffing shortages
P2 Management Minute: Hiring practice staff
P2 Management Minute: Defeating payer denials
Tips for controlling overhead costs
What is P2 Management Minute?
© 2025 MJH Life Sciences

All rights reserved.