American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Time

Beginning in 2021, total time on the date of the encounter may be used instead of MDM for office/outpatient EM code selection. Time has been redefined from "typical face-to-face time" to the sum of both face-to-face and non-face-to-face services of the physician or QHP on the date of the encounter. In addition, time may be used to select a code level for office/outpatient EM services whether or not counseling and/or coordination of care dominates the service.

The table below highlights the changes in time reporting requirements for office/outpatient E/M codes.

CPT Code

Reporting Time Prior to 2021

Reporting Time Effective in 2021

New Patient

99201

Typically, 10 minutes are spent face-to-face with the patient and/or family

Deleted for 2021

99202

Typically, 20 minutes are spent face-to-face with the patient and/or family

15-29 minutes total time on day of encounter

99203

Typically, 30 minutes are spent face-to-face with the patient and/or family

30-44 minutes total time on day of encounter

99204

Typically, 45 minutes are spent face-to-face with the patient and/or family

45-59 minutes total time on day of encounter

99205

Typically, 60 minutes are spent face-to-face with the patient and/or family

60-74 minutes total time on day of encounter

+G2212

New for 2021

Each additional 15 minutes after 74 minutes on day of encounter

Established Patient

99211

Typically, 5 minutes are spent performing or supervising these services

Time does not apply 

99212

Typically, 10 minutes are spent face-to-face with the patient and/or family

10-19 minutes total time on day of encounter

99213

Typically, 15 minutes are spent face-to-face with the patient and/or family

20-29 minutes total time on day of encounter

99214

Typically, 25 minutes are spent face-to-face with the patient and/or family

30-39 minutes total time on day of encounter

99215

Typically, 40 minutes are spent face-to-face with the patient and/or family

40-54 minutes total time on day of encounter

+G2212

New for 2021

Each additional 15 minutes after 54 minutes on day of encounter

Examples of Using Time for Code Selection Beginning in 2021

The following clinical scenarios provide examples of using time for reporting an office visit for an established patient with a new 2-cm lump on the lower back.

Scenario A: On the day of the visit, Dr. Smith spends 5 minutes reviewing a patient's chart while clinical staff gowns the patient and takes vitals. Dr. Smith then spends 15 minutes updating the patient's history and performing a brief examination of the patient's back. Based on a review of the chart and the H&P, Dr. Smith determines the lump is a lipoma that does not require treatment. After the patient leaves the office, Dr. Smith completes the notes about the visit in the patient's chart. Dr. Smith spent a total of 25 minutes in face-to-face and non-face-to-face E/M services related to this patient encounter on the day of the visit. If time were used for code selection, Dr. Smith would report CPT code 99213 (i.e., 20-29 minutes total time), even though the presenting problem was minor and required no treatment.

Scenario B: On the day of the visit, Dr. Smith spends 5 minutes reviewing a patient's chart while clinical staff gowns the patient and takes vitals. In this scenario, the patient is obese and has limited mobility. It takes Dr. Smith a few extra minutes to position the patient for an examination of the lower back and then reposition him to sitting. The patient also has limited English proficiency and his son who came with the patient helps with translation. This results in Dr. Smith spending 20 minutes face-to-face with the patient. Based on a review of the chart and the H&P, Dr. Smith determines the lump is a lipoma that does not require treatment. After the patient leaves the office, Dr. Smith completes the notes about the visit in the patient's chart. In this scenario, Dr. Smith spent a total of 30 minutes in face-to-face and non-face-to-face E/M services related to this patient encounter on the day of the visit. If time were used for code selection, Dr. Smith would report CPT code 99214 (i.e., 30-39 minutes total time), even though the presenting problem was minor and required no treatment.