Eli's Rehab Report
No Timed-Procedure Billing Guidelines? Try This
PDF
Question:
South Carolina Subscriber
Answer: I would refer you to the December 2003 edition of CPT Assistant, published by the American Medical Association. On pages 5-6, while discussing manual therapy, the AMA states, "as with any 15-minute timed code, it is important to recognize that a substantial portion of 15 minutes must be spent in performing the pre-, intra-, and post-service work in order to report code 97140."
This would also apply to all time-based codes. Keep in mind, however, that most payers do not define "substantial," which means it is up to your judgment.
The AMA also gives an example of providing manual therapy for 25 minutes, and it says that would justify billing two units of manual therapy.
In addition, the AMA states specific payers may have their own rules regarding "substantial" amount of time to bill a unit of a timed-based CPT code. You can find this in the February 2004 edition of CPT Assistant. To purchase back-issues of this publication, go to https://catalog.amaassn.org/Catalog/product/product_detail.jsp?productId=prod900004.
Eli's Rehab Report
- Audits:
Think an Auditor's Decision Means the End-of-Story? Think Again!
See how one CORF fought -- and won some money back. Don't be afraid to dispute [...] - Billing:
Gear Up for Q1 With These Deductible Collection Tips
Save time, effort by learning the pros and cons of up-front collection. Collecting deductibles from [...] - Long-Term Care:
MDS 3.0 Is Coming: Get the Scoop on Therapy Changes
Say hello to a more accurate assessment tool. If you provide therapy in a skilled [...] - SNF Reimbursement:
MDS 3.0: Section G Changes Likely to Stir the Pot
Drastic ADL scoring changes could wipe out the RMX RUG category. If you work in [...] - READER QUESTIONS:
Avoid Billing Pitfalls With 97012 and 97140
Question: One of my therapists performed a suboccipital myofacial release with a patient for 10 [...] - READER QUESTIONS:
No Timed-Procedure Billing Guidelines? Try This
Question: Which guidelines should I use when billing timed procedures to non-Medicare carriers who haven't [...] - READER QUESTIONS:
Know the Billing Criteria RACs Will Be Referencing
Question: In the December issue of Eli's Rehab Report, Vol. 15, No. 12, your article [...] - NEWS BRIEFS:
Hospital Outpatient PT May Wrestle With Medicaid Reimbursement
If you provide outpatient therapy services in a hospital setting, pay attention to the latest [...] - NEWS BRIEFS:
Physical Therapy Clinic Pays Up for Anti-Kickback Violations and More
Advanced Centers for Orthopaedic Surgery and Sports Medicine Inc. and Maryland Sportscare and Rehabilitation agreed [...] - NEWS BRIEFS:
Check Out the New WHO Wheelchair Guidelines
The World Health Organization recently launched new guidelines on providing manual wheelchairs in "less resourced [...] - NEWS BRIEFS:
U.S. Physical Therapy Acquires San Antonio Clinics
Physical therapy giant U.S. Physical Therapy announced on Nov. 18 that it acquired a 65 [...] - CLINICAL REHAB ROUNDUP:
Consider Low-Frequency Electric Muscle Stimulation for Total Hip Arthroplasties In this recurring feature, Eli’s Rehab [...]