Wiki Billin 96101 for 10 hrs - Is there anything that states doc has to substantiate hrs ?

[lamreed]

Does anyone know of anywhere that states a doctor's records need to document their face to face time/testing time and also their interpreting or report time?

We billed for 10 hours and now the insurance carrier is asking for our records.
While the doctor didn't document anything in the records. The doctor estimated the amount of time he spent and told us what to bill. But we have nothing in writing.

 

[mitchellde]

any time you are billing by time for any service the time must be documented in the patient record not estimated. Most payers for services beyond one unit will request this be documented for example as "time in 2:30," then "time out 6:45" the provider must be face to face with the patient the entire time or time spent in test interp. and it must be very clear what part is face to face and what part is spent doing the interp. If the payer is requesting the chart notes and there is nothing documented it could be a definite issue. You cannot add this now, "it is as it was" at the time the claim was submitted. if there is absolutely nothing documented, then you have a very definite problem.

 

[willjv]

Per CPT, 96101 is reported "per hour of the psychologist's or physician's time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report".
Anytime you are reporting a time based code, the documentation must support the time being reported. This would be the same as when choosing an E/M code based on time spent counseling. Face to face time, that more than 50% was spent in counseling and what counseling consisted of would be required to bill based on time.

 

[mchb72767]

Always have documentation to back up your billing especially for 10 hours! 96101 is per hour of testing....both face to face and time administering tests to the patient and time interpreting the test results and preparing the report (this is per the CPT manual). Becarefule when Billing for more than 4-6 hours without proper documentation.

Just my opinion here.