Except where CPT guidelines state otherwise, follow these four tips to ensure you’re reporting time-based services correctly.
Many services within the CPT codebook include a time component. Except where CPT guidelines state otherwise, follow these four tips to ensure you’re reporting time-based services correctly.
1. Count only included services
When calculating time spent performing a procedure or service, include only those items specifically detailed in the code descriptor. For example, when reporting critical care services (e.g., 99291-99292), you may include the time spent interpreting cardiac output measurements or chest X-rays, performing ventilatory management or vascular access, and other services enumerated within CPT as inclusive of critical care. You may not count toward critical care the time spent performing other, separately reportable services (e.g., endotracheal intubation for airway support, 31500).
Carefully review CPT guidelines and code descriptors to determine which activities you may count toward the time of a particular service. Each code category or descriptor may include different components within a time-based code. For instance, critical care includes floor/unit time, in addition to time spent at a patient’s bedside. I contrast, when calculating time for prolonged services 99354-99357, you may count only “face-to-face” time. Many time-based services include only that time spent “face to face” with the patient. Count time away from the patient only if the code descriptor or other CPT guidelines specifically allow you to do so.
Bonus tip: As a best practice, when providing time-based services, you should document start and stop times, as well as the total time of service.
2. Pass the “midpoint” before billing a time-based service
If a code describes the “first hour” of service, you must provide and document at least 31 minutes of service. Likewise, if the unit of service is 30 minutes, you must perform and document at least 16 minutes of service (and so on). If the service does not meet the minimum time required, either you may not separately report the service, or you should report an (other) appropriate evaluation and management service code. For instance, if you provide fewer than 30 minutes of critical care (99291), CPT instructs you to report “appropriate evaluation and management codes.”
Some codes describe “24-hour services.” In most cases, you must document at least 12 hours of service to report such codes. For services lasting fewer than 12 hours, you may need to append modifier 52 reduced services. Be sure to review CPT guidelines before assigning codes or modifiers.
3. Select the “closest” code
Per CPT guidelines, “When codes are ranked in sequential typical times and the actual time is between to typical times, the code with the typical time closest to the actual time is used.”
This rule applies when reporting evaluation and management services using time - rather than the key components of history, exam, and medical decision-making - as the determining factor in the level of service (e.g., if counseling and/or coordination of care comprise more than half the encounter). In such cases, you should use CPT “reference times” to determine an appropriate evaluation and management service level.
For example, a Level 3 established patient outpatient visit (99213) has a reference time of 15 minutes, and a level 4 service (99214) has a reference time of 25 minutes. When reporting a time-based evaluation and management service lasting 19 minutes, you would report 99213 because it has the closest reference time.
4. Use the initial DOS for continues services
CPT states, “For continuous services that last beyond midnight, use the date in which the service began and report the total units of time provided continuously.”
For instance, if intravenous hydration begins at 10:30 p.m. and lasts until 1:30 a.m. the next calendar day, you would report 96360 Intravenous infusion, hydration; initial, 31 minutes to 1 hour once and 96361 …each additional hour (List separately in addition to code for primary procedure) twice. You would not report a new “initial” service (96360) on the new calendar date, unless that service truly represents a different session or encounter with the patient.
G. John Verhovshek, MA, CPC, is managing editor at AAPC, the nation’s largest training and credentialing organization for the business side of healthcare.