Current E/M
Using time to select the level for E/M services
Using time to determine the level of service: In a nutshell
The level of service can be selected based on total time spent by the dermatologist or other qualified non-physician clinician on the date of the encounter.
Time spent by clinical staff is not included in calculation of total time.
Total time includes face-to-face and non-face-to-face time spent in pre-, intra-, and post-encounter activities.
Provision of counseling and/or coordination of care is not required in the selection of the level of service based on total time.
Time
The level of E/M service (CPT codes 99202-99205 or 99212-99215) may be based on medical decision making (MDM) OR total time spent by the dermatologist or other qualified non-physician clinician on the day of the encounter. This time may include counseling and/or coordination of care, but these services are no longer the only determining factor for choosing a time-based level of service.
Calculating Total Time
Total time is considered all the time spent in both face-to-face and non-face-to-face activities on the day of the encounter. Total time includes the time personally spent performing activities that require the dermatologist or non-physician clinician but does not include time in activities normally performed by clinical staff. For services provided by clinical staff under direct supervision of the dermatologist or non-physician clinician, report CPT code 99211.
Examples of the pre-, intra-, and post-activities that, when performed by the dermatologist or other qualified non-physician clinician on the day of the encounter, can be considered when calculating total time include:
review of tests as dermatologist or non-physician clinician prepares to see the patient,
obtaining and/or reviewing separately obtained history,
performing a medically necessary appropriate examination and evaluation and counseling and/or educating the patient/family/caregiver.
When the time spent on the day of the encounter assessing and managing the patient is split between a dermatologist and non-physician clinician, sum the time each spends and report as combined total time. Any time jointly spent by both the dermatologist and non-physician clinician together in the assessment and management of the patient is counted as a single unit of time. The visit is reported only once based on the total time spent for the encounter.
Selecting the code based on total time
Total time is assigned to each code using increments of time ranges. Use the chart below to select the appropriate code based on the total time documented for the encounter.
| New Patient | Total Time Spent | Established Patient | Total Time Spent |
|---|---|---|---|
99202 |
15 minutes |
99212 |
10 minutes |
99203 |
30 minutes |
99213 |
20 minutes |
99204 |
45 minutes |
99214 |
30 minutes |
99205 |
60 minutes |
99215 |
40 minutes |
Use the Current E/M coding tool
The Academy has released a version of the E/M coding tool for the current guidance, to help dermatologists select the appropriate code.
Use the tool
You can test your knowledge of E/M coding by taking a short Academy quiz, or see other coding quizzes.
Related Academy resources
Go to tabbed 2020 E/M coding pages for detailed guidance. There is also a 2020 coding tool.
Our coding staff experts will respond to your query within 48 business hours.
Get the latest information about accurate diagnostic and procedural coding and Medicare reimbursement issues in dermatology.
