Applying the Midpoint Rule

[Back.end.dev]

How are you all applying the midpoint rule when billing time based E/M services under the 2021 guidelines?, a few providers documenting total time in notes for example, "spent 23 minutes with patient", also for office visits, and I know for CPT codes like 99214 (30–39 min), the midpoint of 30 minutes allows you to code up if the time lands at 50% or more of the range, so technically, 23 minutes hits the halfway point for 99214. But I've seen mixed interpretations floating around.
Are you guys rounding up based on midpoint, or sticking to the full time minimum listed per code?

 

[sammywammy]

How are you all applying the midpoint rule when billing time based E/M services under the 2021 guidelines?, a few providers documenting total time in notes for example, "spent 23 minutes with patient", also for office visits, and I know for CPT codes like 99214 (30–39 min), the midpoint of 30 minutes allows you to code up if the time lands at 50% or more of the range, so technically, 23 minutes hits the halfway point for 99214. But I've seen mixed interpretations floating around.
Are you guys rounding up based on midpoint, or sticking to the full time minimum listed per code?

We stick to the full time minimum just to be safe, especially with audits getting stricter. There are those payers who accept midpoint rounding, but unless it's clearly backed by their policy, it's... I don't know... unsure. I think it's better to code clean than risk it.

 

[cleanclaimPr0]

Based on what I've gathered about the 2021 E/M guidelines, it seems like the midpoint rule is pretty much a thing of the past for time-based billing. Now, like sammywammy said, you have to meet the full minimum time for the code, for instance, 99214 requires a total of at least 30 minutes.

So, if you're documenting just 23 minutes, that falls short of what's needed to bill 99214 based solely on time.

I'm wondering, are providers rounding up anyway, or are they really sticking to those minimum times? I'd love to hear how others are handling this in real-life situations

 

[HAYABUSA]

How are you all applying the midpoint rule when billing time based E/M services under the 2021 guidelines?, a few providers documenting total time in notes for example, "spent 23 minutes with patient", also for office visits, and I know for CPT codes like 99214 (30–39 min), the midpoint of 30 minutes allows you to code up if the time lands at 50% or more of the range, so technically, 23 minutes hits the halfway point for 99214. But I've seen mixed interpretations floating around.
Are you guys rounding up based on midpoint, or sticking to the full time minimum listed per code?

We follow the listed time ranges exactly now. Ever since the 2021 changes, midpoint rounding has felt too risky without something in writing from the payer. I feel like we have got the same experiences over here. Audits are getting stricter yes as mentioned by @sammywammy here. We can't afford errors.

 

[c0dex_br3nt]

How are you all applying the midpoint rule when billing time based E/M services under the 2021 guidelines?, a few providers documenting total time in notes for example, "spent 23 minutes with patient", also for office visits, and I know for CPT codes like 99214 (30–39 min), the midpoint of 30 minutes allows you to code up if the time lands at 50% or more of the range, so technically, 23 minutes hits the halfway point for 99214. But I've seen mixed interpretations floating around.
Are you guys rounding up based on midpoint, or sticking to the full time minimum listed per code?

I agree with these guys, under the 2021 E/M guidelines for office visits, the midpoint rule does not apply.
You need to meet or exceed the minimum time listed for the CPT code.
So, for a 99214, which has a range of 30-39 minutes, you'd need to hit at least 30 minutes to bill that code based on time.
23 minutes would likely fall into a lower E/M code based on time, or you'd need to consider the MDM to select the appropriate level.