What is the difference between E/M code "visit level" determination by time versus history/physical/MDM?

• A. Time-based E/M level is used when most of the visit is spent on counseling/coordination; otherwise, history, exam, and MDM determine level.
• B. Time-based is always used, regardless of components.
• C. History alone determines the level.
• D. MDM alone determines the level.

Answer: (A)

The idea being tested is that an E/M visit can be priced using two pathways: a standard component-based method and a time-based method. In the component-based method, you determine the level by counting the documented history, the extent of the examination, and the complexity of medical decision making. In the time-based method, you determine the level from the total time spent with the patient on the date of the encounter, but only when most of that time is spent on counseling and/or coordination of care.

When most of the visit is devoted to counseling the patient and coordinating care with others, the time-based approach is appropriate. You document the total time and select the level that corresponds to that amount of time. If counseling/coordination does not predominate, you use the standard rubric of history, exam, and MDM to choose the level.

History alone or MDM alone do not determine the level; the coding either uses the combined components (history, exam, MDM) or uses total time when counseling/coordination dominates.