For Billing Compliance, Don’t Overlook Units
By Torrey Kim, CPC
Do you rely too much on your software? A physical therapy practice’s software generated one unit of 97010 for every 15 minutes that the patient sat with an ice pack on his leg — even though 97010 is not a timed code. A hospital overbilled more than $1 million in charges for various errors, one of which was that they billed epoetin alpha dosage strength in the units field.
These practitioners pointed to software as the source of errors. On the plus side, these examples show that coders won’t be replaced by software anytime soon. On the downside, it demonstrates that coding professionals may not be as diligent as they should when doublechecking computer-generated claims.
Don’t Take Units Lightly
Although some coders can recite units in their sleep, others don’t process claims with units as often, and can get confused when asked how many units to report.
One anesthesia practice relied so heavily on its software to generate unit numbers, the coders were unsure of how the formula was derived. When it came time to set up a new software system, the coders didn’t know whether to program it to ask for minutes that the physician spent with the patient, or number of units to report.
For example, if the physician performed conscious sedation (99144) for 30 minutes, the practice didn’t know whether to enter “30” in the units field or “1.” (The answer is “1.”) Likewise, physical therapy practices are accustomed to many of the PT codes stating, “each 15 minutes” in the descriptors. If the therapist performs therapeutic exercises with the patient for 45 minutes, the practice should bill three units of 97110. However, some PT codes are not time-based, a fact PT coders might overlook. One PT practice noted that its coder billed two units of 97010 for 30 minutes of hot/cold pack application, even though the code should be reported just once, no matter how long the patient uses the packs. The practice stated that it was a software error: They had accidentally set up the billing program to ask for minutes spent with a patient for every procedure, not just those that should be billed according to time.
A recent OIG audit showed that a hospital billed epoetin alfa according to the dosage strength. “For example,” the audit noted, “instead of billing 8 units, the provider billed 8,000 units.” Usually, code descriptors will indicate whether a code should be reported with one unit per amount of time spent (such as 97110 or 99144) or based on one unit per specified dose (such as J0895 for deferoxamine mesylate, which is billed at one unit of service for every 500 mg administered).
Your best bet is to keep a close eye on your “units” field when reporting your services, and double-check your software on an ongoing basis.