Pass the “Midpoint” Before Billing a Time-Based Service

by John Verhovshek, MA, CPC

If a code describes the “first hour” of service, you must provide and document at least 31 minutes of service. Likewise, if the unit of service is 30 minutes, you must perform and document at least 16 minutes of service (and so on). If the service does not meet the minimum time required, either you may not separately report the service, or you should report another appropriate code. For instance, if you provide fewer than 30 minutes of critical care (99291), CPT® instructs you to report “appropriate evaluation and management codes.”

Some codes describe “24-hour services.” In most cases, you must document at least 12 hours of service to report such codes. For services lasting fewer than 12 hours, you may need to append modifier 52 Reduced services. Be sure to review CPT® guidelines before assigning codes or modifiers.

Remember: As a best practice, physicians providing time-based services should report the total time of service, and start and stop times.

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John Verhovshek

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.

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