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Evaluation and Management -Time Based Code Selection

The following codes are used to report evaluation and management services provided in the office and or outpatient setting.

The office and or outpatient setting codes CPT 99202 to 99215, the time guidelines had been changed effective from Jan 1. 2021. 

There are few changes with exiting guidelines,

The Counseling and/or coordination of care with other physicians, other qualified health care professionals has been removed and included following guidelines. 

In 2021, The time guidelines explain about that for 99202-99205 and 99212-99215, The total time spends on the encounter for the date, includes both face-to-face and non-face-to-face time spent by the provider.

Physician/other qualified health care professional time includes the following activities when performed,

  • Preparing to see the patient (eg, review of tests)
  • Obtaining and/or reviewing the separately obtained history
  • Performing a medically appropriate examination and/or evaluation
  • Counseling and educating the patient/family/caregiver
  • Ordering medications, tests, or procedures
  • Referring and communicating with other health care 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/caregiver
  • Care coordination (not separately reported)
The appropriate CPT codes can be selected based on the time documented in the visit notes. 

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