If you look through Current Procedural Terminology (CPT), you will notice that many of the Evaluation and Management (E/M) code descriptors include typical times. These typical times are averages of how long it takes a physician to complete all components of a visit at that level. As is true with averages, some times will be higher and some will be lower, depending on the actual clinical circumstances. Therefore, in most cases, time is only a “contributory factor” in determining which E/M level to report for a visit. Usually, a level of E/M service is determined by the key components—history, physical examination, and medical decision making. However, if you end up spending more than 50% of the visit counseling or coordinating care, you can use time as the key factor when determining the level of E/M service to report.For example, you see a 20-month-old child with an injured leg and complete 2 of the 3 key components (expanded problem-focused history, expanded problem-focused examination, or medical decision making of low complexity) necessary to code 99213. On review of the chart, you notice that the child has not yet received his or her varicella vaccine, and you mention this to the parent. The parent agrees to have it done during the visit. However, before you can discuss the vaccine in greater detail with the parent, he or she starts talking about a television program on the link between autism and vaccines. You answer all of the parent’s questions and end up spending quite a bit of time in counseling the child and parent.If you look at CPT, you will note that 99213 has a typical time of 15 minutes, while 99214 has a typical time of 25 minutes. To determine whether you can code for time as the key factor, answer the following questions:If the answer to question 3 is equal to or less than 50%, the key components should be used to determine the level of code to report. If the answer to question 3 is greater than 50%, use time as the key factor when determining which level of service to report; the level of key components is no longer a factor.From the previous example, if the answer to question 2 is 30 minutes and the answer to question 1 is 16 minutes, the answer to question 3 is 53% and you can report 99214 (the typical time listed in CPT for 99214 is 25 minutes).The following are variations with different results:NOTE: In every case, it is imperative that you document the extent of the counseling or coordination of care in the medical record.