Wiki Documentation of Time for each timed CPT code for therapy

[medicalauditor]

Hello - I am confused with CMS guidance about documentation of time for timed CPT codes and the 8-min rule. CMS says - "Documentation of each Treatment shall include the following required elements:
• Total timed code treatment minutes and total treatment time in minutes. Total treatment time includes the minutes for timed code treatment and untimed code treatment. Total treatment time does not include time for services that are not billable. (e.g., rest periods). For Medicare purposes, it is not required that unbilled services that are not part of the total treatment minutes be recorded, although they may be included voluntarily to provide an accurate description of the treatment, show consistency with the plan, or comply with state or local policies. The amount of time for each specific
intervention/modality provided to the patient may also be recorded voluntarily, but contractors shall not require it, as it is indicated in the billing. The billing and the total timed code treatment minutes must be consistent. See Pub. 100-04, chapter 5, section 20.2 for description of billing timed codes;"

Here is my confusion - By "Total timed code treatment minutes", does CMS mean the total time for all timed CPT codes combined, or the time for each timed CPT code? It sounds like they are saying combined time for all timed CPT codes, but then if that's the case, here's my question. As an auditor, if the provider does not document time for each timed CPT code individually, how can I verify that the 8-minute rule was applied properly and that the # of units reported for each timed CPT code are accurate? For example, if the provider documents 1 unit for 97110 and 2 units for 97140 and documents a total of 40 minutes but does not document time for 97110 and for 97140, I do know that 3 units can be billed, but how will I verify if each CPT code is billed with the correct # of units? For instance, if 97110 was performed for 25 minutes and 97140 for 15 minutes, then 97110 should be billed with 2 units and 97140 with just 1 unit. So in the absence of time for each code, how can I audit & how will I know that the provider in this case billed incorrect # of units for each code?
Oh and another thing - All the examples that CMS has given, to demonstrate time calculation, has the time for each CPT code listed individually. So doesn't that mean that the provider needs to document the time individually? But then CMS goes on to say, as stated above, that The amount of time for each specific intervention/modality provided to the patient may also be recorded voluntarily, but contractors shall not require it. !!! This is very confusing. If I can't find a document that states clearly that time for each timed CPT code must be documented, I can't enforce it. Please help and if there is such explicit guidance from CMS, please share the link, I will be grateful.
Thank you.

 

[TThivierge]

Hi Medical Auditor
I am using past experience of medical coding abstractions in listing time. There is certain CPT codes the time must be listed in the med record by the clinician. Examples of timed CPT code needed this in patient's documentation on treatment date by the provider/clinician. Some examples are telehealth(phone or video ), anesthesia, sleep medicine, MH case management, crisis, prolonged, smoking cessation, some beh. health therapy, physical therapy, Etc. You can check the CPT manual which tells you these factors. But the EHR systems will record the time a clinician starts to see a patient, the date, and when finished by signing /attesting the record. Also some time for reviewing med record can be counted, but not added in the treatment time for the patient. Also some CPT codes must have certain amount of treatment done or it is nonbillable . I know for behav. health CPT codes must have at least 15 minutes in order to bill and telehealth 98966 at least 5 minutes. Some CPT codes use 1 units= 15 minutes. So if unit is linked to emergency crisis for mental health , 4 units= 1 hour. The EMR system would be set up for this when the MH clinician plugged in the CPT he or she used by the CPT code= time of 15, 30, 60 minutes. So 2 hours of CPT code uses 8 unit. You would know because the clinician put it in his or her documentation treated the pt. for 30 minutes or 80 minutes Etc. then it would be billed on the claim. One more thing the EHR system would be set up with CPT codes and times hopefully the documentation match up to the claim.
I hope this data helps you a little bit.
Lady T