coding time spent

samyjm13

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A while back I had asked for help on coding time spent for office visits and I got great results, but now, again, I am needing help. It is on the "correct documentation", and if I feel if the documentation is not there I can code down. Is there any guidelines stating this, something I can print out to give to the provider.

Again, thanks for the help, this seems to be a gray area for me.

samy
 
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aaron.lucas

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this is from the AAOS website and details medicare's time guidelines.
Reporting timed services:

Practices typically rely on the therapist or assistant to document required time elements within a progress note or EMR system. Billing staff may use the documentation to confirm the number of service units reported.

The Medicare guidelines for reporting timed services are detailed in Chapter 5, section 20.2, of the Medicare Claims Processing Manual (publication 100-04). Non-Medicare payers may also adhere to these time guidelines. Offices should confirm payer-specific requirements during contracting.

Providers should not bill for services performed for less than 8 minutes when only one service is administered in a day. Time intervals are assigned in increments of 15 minutes, beginning with a base of at least 8 minutes (1 unit is ≥ 8–22 minutes; 2 units are ≥ 23–37 minutes; 3 units are ≥ 38–52 minutes, etc).

This also is an example of the "1/2 way rule", where you need to get half way to the next time unit in order to bill for it. since half way to 15 minutes is 7:30, you round it up to 8 and that's the minimum time for timed PT/OT. similarly for codes with half hour units or hour units, CPT will say you need at least 15 minuts or half an hour respectively to bill for one unit (critical care is a prime example of this). here also is a link to a site with a table that lays out the first 6 units of PT time so you dont have to count so much. http://insurance.lovetoknow.com/Medicare_8_Minute_Rule

Hope this helps! :)
 

samyjm13

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Time coding

Thanks for the info, but these are office visits not PT, I guess I should have said that. But still will look on the AAOS sight.


samy
 

aaron.lucas

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OH, sorry, in that case all you want to know if more than half the visit is spent on counseling and coordination of care, and then the time itself has to be documented as well. as far as how much time you need, CMS says that what's in the CPT book is the minimum you need (i.e., 25 minutes for 99214), and the AMA says those times are averages. sorry I was confused at first.
 
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