It’s Time to Talk about Time for Office Billing in 2021

Original story posted on: May 17, 2021

It’s about time.

I talked about the medical decision-making element regarding the updated 2021 Office and Ambulatory Services Evaluation and Management (E&M) Guidelines a few weeks ago. Today, I am going to go over selection of E&M levels of service (LOS) according to time.

In other Current Procedural Terminology (CPT®) E&M guidelines and for previous office/outpatient visits, time-based billing has a “typical time” specified, and there is a requirement that the provider must exceed that typical time, and greater than 50 percent of the time must be spent in counseling and/or coordination of care. Best-practice documentation has the provider attesting to exactly these specifications and giving some points as to what was discussed or addressed in the counseling or coordination of care.

The updated office or other outpatient and prolonged services codes now hinge on amount of time, plain and simple.

Time-based Billing for Office and Ambulatory Outpatient Services 2021

New pt E&M  codes

Total time in minutes


Established pt E&M codes

Total time in minutes


Code deleted



No time based





















Counseling and coordination of care can be elements of what was done during the encounter, but they no longer need to dominate the service visit. Time can include both face-to-face (F2F) and non-F2F time now. The time is added over the course of the calendar day, and it does not need to be sequential.

Here’s what time encompasses:

  • Preparation to see the patient, such as reviewing tests done prior to the visit;
  • The provider obtaining their own history and/or reviewing history obtained by someone else, like a medical assistant;
  • Performance of a medically appropriate physical examination;
  • Counseling and education of the patient, a family member, and/or a caregiver;
  • The ordering of medications, tests, or procedures, including whatever machinations it takes to accomplish that, such as electronic order entry;
  • Referring and communicating with other healthcare professionals;
  • Documenting in the health record, whether electronically, by dictation, or handwriting;
  • Independently interpreting results (not separately reported) and communicating results to the patient or surrogate; and
  • Care coordination, if not billed under a separate care coordination CPT code.

Here is what is excluded:

  • If the provider and another qualified healthcare professional both see a patient, only one person can claim any given minute of time – you can’t double-dip, even if two individuals are in the same room at the same time. Keep in mind that office-based encounters are only eligible to be billed as incident-to, not split/shared visits.
  • A service that is separately reported or billed can’t be counted towards the E&M LOS.
  • Time spent traveling; and
  • Teaching that is general and not limited to the discussion required for the management of a specific patient.

If your documentation template has a place to indicate time, and more than one person has signed the chart (like an APP and a supervising physician), if someone is planning on using time as their component for determining level of service, be sure that it is clear whose time is being claimed. The time would not be additive. The physician can’t take credit for time the APP invested.

Although time is often guesstimated, as opposed to formally being clocked in and out with a stopwatch, the provider should try to be accurate. If they were to get audited and the cumulative time claimed in a day exceeded the workday (or, even worse, 24 hours), there would be serious repercussions.

Finally, social time doesn’t count, either. There is no medical necessity to make small talk about the patient’s family member’s wedding or the patient’s newfound love of birding during the pandemic. Although discussing niceties may be endearing and increase patient satisfaction, there is no associated reimbursement.

To indicate billing based on time, the provider could develop an attestation that has a field to enter a specific amount of time, and note that the total time includes face-to-face and non-face-to-face time (including, but not limited to…). Here they could list a few of the activities that count toward total time, as bulleted above. It does not have to be comprehensive, but should support the amount of time being claimed.

Get your providers educated and their documentation prepared. Don’t waste time getting the provider credit for time-based billing!

Programming Note: Listen to Dr. Erica Remer when she co-hosts Talk Ten Tuesdays with Chuck Buck, Tuesdays at 10 a.m. Eastern.

Erica E. Remer, MD, CCDS

Erica Remer, MD, CCDS has a unique perspective as a practicing emergency physician for 25 years, with extensive coding, CDI, and ICD-10 expertise. She was a physician advisor of a large multi-hospital system for four years before transitioning to independent consulting in July 2016. Her passion is educating CDI specialists, coders, and healthcare providers with engaging, case-based presentations on documentation, CDI, and denials management topics. She has written numerous articles and serves as the co-host of Talk Ten Tuesdays, a weekly national podcast. Dr. Remer is a member of the ICD10monitor editorial board, a former member of the ACDIS Advisory Board, and the board of directors of the American College of Physician Advisors.

Related Stories

  • E&M Documentation Seems to Remain the Same
    Why are providers not using the new rules to their advantage? This past week, I was sitting in a new client’s office (finally!) in Georgia reviewing ear, nose, and throat (ENT) documentation. I temporarily lost my audit focus, because I…
  • E&M Guidelines: Taking a Close Look
    Chronic or acute: questions persist in the new guidelines. You know, we have been using the new evaluation and management (E&M) guidelines for 96 days now, and if they had the ease and efficiency, we were told they had, I…
  • The Devil is in the Data: A Detailed Look at MDM Changes for 2021
    Major changes are found in the 2021 Evaluation and Management guidelines. As we enter the final quarter of 2020, I hope everyone is committed to being prepared for the 2021 evaluation and management (E&M) changes, because they’re locked in, and…