Wiki Diabetes counseling 45 mintues

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mfanning

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Hi all -

If diabetes counseling goes over 30 minutes, but is less than an house (say 45 minutes), would you bill 98960 and 98960-52?

Thanks!:)
 
I would think that it would have to be the full hour to be able to bill the 98960 twice. I have been doing some research on diabetic education though and it has been recommended to bill it as G0108. 98960 is not a billable service through medicare and most commercial insurances follow suit. I could be wrong but that is just what I dug up through talking to other people as well as specific diabetic educators through our hospital.
 
I have used 98960 and been reimbursed via Medicare and commercial, it is a timed service and can be billed in units, you must be 15 minutes into the 2nd unit to bill 2 so 44 minutes is 1 unit and 45 is 2. As to whether this is a G0108 or a 98960 really depends on documentation.
 
Debra,
I had this question arise this week and wondering if we can bill 1 unit of 98960 if it didn't meet 30 minutes? Documentation reads 10 minutes, did not meet 30. Should we report 98960?
 
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I have been out of town with no internet for the last 10 days so I have not been able to reply till now, but you must have documentation of at least half of the required time to report. So a 30 minuted code must have a minimum of 15 minutes documented or there is no code.
 
It is the rule of timed services any timed service must have one half of the required time in order to bill the first unit, then for the second unit you must be one half into it before it can be bill, a 30 minute service must be a min of 15 minutes, the next unit is also 30 minute which means you must be 15 minutes over the 30 minutes of the first unit, hence 45 minutes for the second unit. This is documented in the Medicare manual I am not certain the section, the most recent was with the prolonged services section.
 
98960 at 45 minutes x2 units

debra and/or jackson

I went tot the IOM 100-2 Chapter 12, Section 30.6.15.1 and I cannot find the verbage that states that if a timed code of 30 minutes is coded per unit, that a 45 minute visit would justify the provider to bill 98960 X2.

Can you help a bit more on this please?
 
Debra Mitchell
I was under the impression that the timed services were only for physical therapy codes. I have not been able to find anything to support that this would apply to CPT 98960. Help?
 
98960 is a timed service look in your CPT book it says every 30 minutes. The guideline for timed services is across the board not just physical therapy.
 
Reference

I'll review my documentation tomorrow. But based on my reading, there is a strict basis for coding the first 30 minutes. If it is 29 minutes, cannot round up and cannot code for any. For additional minutes past 30, and again want to review my notes, there is more leeway, for coding an additional unit. Just want to have the documentation in front of me.
 
Therre is a section in the CMS manual on coding for Prolonged time codes (99354-99357) in this they provide a chart of the threshold (minimum) times allowed to charge these codes, the 99354 is a 60 minute code the threshold is 30 minutes above the visit time and a 99355 is a 30 minute code the threshold is 15 minutes above the first hour of 99354. I am not sure where you are reading the strict 30 minute thing. The only code that they are strict about is hydration which has to me a minimum of 31 minutes to count the first unit. However there are good reasons for that one. Also look in your CPT book under the 99354-57 section there is a chart that also explains the minmum times. Again this logic applies to all time codes with the exception of hydration.
 
Reference additional

http://medicalnewswire.com/artman/publish/article_8156.shtml

This reference above dated 2006 suggests 30 minutes, and additional requirements, qualifies for 98960.

http://www.nysdiabetescampaign.org/...raining-Offered-to-Medicaid-Beneficiaries.pdf

This second reference states that multiple units of 98960 can be billed.

https://www.diabeteseducator.org/Members/Reimbursement_QxA.html

This third reference states that there is no "specific guidance" for rounding up or down.

This gets back to time based coding (previous posting reference chapter 12) which does provide better guidance for rounding up or down. As per mitchellde's post above.
 
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