Time is of the essence: coding on the basis of time for physician services.

I n the world of coding, time is perplexing. On the one hand, time is built into the evaluation and management (E/M) codes, so physicians are told to base their E/M code selection on the history , exam and medical decision-making elements , not on time spent. Times are listed for each service in the CPT manual only as a guideline. On the other hand, CPT lists a variety of codes that are strictly time dependent and even has codes for prolonged services. As a result, there is much confusion around the importance of time, especially when coding unusually long office and inpatient visits. With a correct understanding of time and how it relates to coding, physicians can know when a higher code may be justified even though the history, exam and medical decision-making elements are lacking. They can also know how to code the following vexing situations: 1. The asthma flare-up that requires two hours of office time; 2. The patient who requires 25 minutes of your time reviewing problems, adjusting medications, counseling and coordinating care, but who does not require an extensive exam or complex medical decision making; 3. The visit devoted to counseling on Dr. Sophocles is a family physician practicing in Denver and a clinical professor at the