Part B Insider (Multispecialty) Coding Alert

Published on Tue Mar 28, 2006 PDF

Understand Unit Numbers When Coding Therapy Services

Question: A therapist performed 8-minute massages to a Medicare patient's left leg, upper back and lower back, totaling 22 minutes of massage. Which should I report?:

A. CPT 97124 -LT, 97124, 97124--One unit for the left leg, one for the upper back, and one for the lower back.

B. 97124 x 2--Rounding the time down to 20 minutes, report 2 units according to the 8-minute rule.

C. 97124 x 2--According to the 8-minute rule, greater than or equal to 22 minutes means that I should report 2 units.

D. 97124--Medicare indicates I should report any period between eight and 23 minutes as one 15-minute unit.


Utah Subscriber


Answer: You can eliminate option A because 97124 (Therapeutic procedure, one ore more areas, each 15 minutes;...) contains the phrase "one or more areas" in its descriptor. "You should therefore assume every area you focus on is included in that code already," says  Heather Corcoran, coding manager at CGH Billing Services in Louisville, KY. Caution: "To try and collect more money for more than one area is considered upcoding," she points out.

Although you're not restricted to using an anatomic modifier, such as modifier LT (Left side), you should count the arm, upper back and lower back as "one or more areas" and leave modifier LT out.

As for Option B, you should never round timed units down or up, Corcoran says. That may mean charging more than you should and may result in scrutiny by the Office of Inspector General. "What's in the documentation should be accurate, and you should choose the number of units based on what's there. Otherwise, you're putting yourself at risk," she warns.

Option C is a trick question. The 8-minute rule specifies that time greater than or equal to 23 minutes means you should report 2 units. That's 23 minutes, not 22. Because 22 minutes is less than 23 minutes, you should report only one unit of 97124.

Correct answer: Option D.