COMMENTARY

Getting Paid for Helping Other Doctors; Reimbursement for Time Spent Before and After Seeing a Patient

Betsy Nicoletti, MS

Disclosures

October 20, 2020

2021 Rules for Coding for Time Spent Pre- and Post-visit

Q: Can you tell me more about the changes for 2021 when coding for time that includes previsit and postvisit time and face-to-face time? What is the inclusive number of days for previsit and postvisit days from the actual date of service? Is it 7 days or 14 days pre-visit and post-visit? How do we document it?

A: Only previsit and postvisit time on the day of the office or outpatient visit (99202-99215) may be included (Table 2). Time spent on prior or subsequent days may not be included in time when using time to select a code.

Physician or other qualified healthcare professional time includes the following activities, when performed:

  • Preparing to see the patient (eg, review of tests)

  • Obtaining and/or reviewing separately obtained history

  • Performing a medically appropriate examination and/or evaluation

  • Counseling and educating the patient, family, or caregiver

  • Ordering medications, tests, or procedures

  • Referring and communicating with other healthcare professionals (when not separately reported)

  • Documenting clinical information in the electronic or other health record

  • Independently interpreting results (not separately reported) and communicating results to the patient, family or caregiver

  • Care coordination (not separately reported)

Only the time of the billing practitioner may be used, and the activity must require that level of skill and knowledge. For example, waiting on hold for prior authorization does not require practitioner knowledge and skill, whereas a peer-to-peer discussion with a physician at the insurance company does.

When the instructions say "when not separately reported," it means you can't double count time spent for the office visit with another service that you are billing with a CPT code, such as chronic care management. Document the activities and total time spent — for example, "I spent 35 minutes reviewing the record, seeing the patient, and documenting the encounter."

Codes 99202-99215 now have time ranges, rather than a single threshold time (Table 2).

Table 2. Time Ranges for CPT Office Visit Codes

CPT code

Time range

99202

15-29 minutes

99203

30-44 minutes

99204

45-59 minutes

99205

60-74 minutes

99212

10-19 minutes

99213

20-29 minutes

99214

30-39 minutes

99215

40-54 minutes

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