time-based coding guidelines
CPT 2003 offers a number of guidelines for time-based coding. The average time and prolonged service guidelines are summarized
here.
Average time guidelines
CPT lists average time guidelines for a variety of services, shown below. While time spent does not determine the level of coding in
most cases, the averages can assist physicians in recognizing prolonged services and coding appropriately.
For visits that involve more than 50 percent counseling or coordination of care, time can determine the level of coding. For example,
if a 30-minute office visit with an established patient involved more than 15 minutes of counseling and coordination of care, you
could automatically code the visit as a 99214.
OFFICE VISITS
Avg. minutes spent
(face-to-face)
INPATIENT CARE
New patient
code
5
10
99201
15
20
Established
patient code
Avg. minutes spent
(floor/unit)
99211
15
30
99212
25
30
99214
50
99232
99222
70
99223
99221
35
99203
40
Subsequent
care code
99231
99213
99202
25
Initial care code
99233
99215
45
99204
60
99205
OUTPATIENT CONSULTATIONS, NEW OR ESTABLISHED
INPATIENT CONSULTATIONS, NEW OR ESTABLISHED
Avg. minutes spent
face-to-face
Consultation code
15
99241
Avg. minutes
spent
(floor/unit)
30
99242
10
40
99243
20
60
99244
30
80
99245
40
99252
55
99253
80
99254
Initial
consultation
code
Follow-up
consultation code
99261
99251
99262
99263
continued
NURSING FACILITY VISITS, NEW OR ESTABLISHED
Avg. minutes spent
(floor/unit)
Annual
assessment code
15
25
30
Subsequent
visit code
Avg. minutes spent
(face-to-face)
99311
15
99312
20
99301
35
99302
50
99303
New patient
code
Established
patient code
99347
99341
25
99313
40
HOME SERVICES
99348
30
99342
40
99349
45
99343
60
99344
75
99345
99350
Prolonged service guidelines
When physicians provide services that require more time than what is typical, they can submit prolonged service codes in addition
to the appropriate evaluation and management (E/M) code. When calculating the number of minutes spent in prolonged service,
do not include the average time allotted by CPT for that E/M code; count only the minutes spent beyond the typical service.
OUTPATIENT CARE
INPATIENT CARE
Minutes of prolonged service
(face-to-face)
Code
Minutes of prolonged service
(floor/unit)
Code
Less than 30 minutes
Not reported separately
Less than 60 minutes
Not reported separately
30-74
99354
60
99356
75-104
99354 plus 99355
61-90
99356 plus 99357
105-134
99354 plus 99355 x 2
91-120
99356 plus 99357 x 2
135-164
99354 plus 99355 x 3
121-150
99356 plus 99357 x 3
165-194
99354 plus 99355 x 4
151-180
99356 plus 99357 x 4
Developed by Aris Sophocles, MD, JD. Copyright 2003 American Academy of Family Physicians. Physicians may photocopy or adapt
for use in their own practices; all other rights reserved. Sophocles A. Time is of the essence: coding on the basis of time for physician services.
Fam Pract Manag. June 2003:27-31; http://www.aafp.org/fpm/20030600/27time.html.
