A 24-year old female with history of asthma presents with acute bronchospasm and moderate respiratory distress. Initial evaluation shows respiratory rate 30, labored breathing, and wheezing heard in all lung fields. Office treatment is initiated, which includes intermittent bronchial dilation and subcutaneous epinephrine. The physician is required to provide intermittent face-to-face time with the patient over a period of two hours. Physician documented a level 4 service, and separate start and stop times totaling 60 minutes.