semantics of "each additional X minutes"

RainMaker

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Many of the time-based CPT codes have descriptions to the effect of "each additional 30 minutes", "each additional 15 minutes", etc.

Is there a general guideline which states what qualifies as the additional chunk of time? Let me explain...

Time: 1 hour, 2 minutes: do we get to count "an additional 30" beyond the first hour?

For critical care time reporting, it is nice that there is a matrix which specifies it in no uncertain terms. :)

But for other services, e.g., 92618 (CPT 2012), it is not clear to me.

Sometimes, some extra wording will make it clear; for instance, 94781 states "each additional full 30 minutes".
 

aaron.lucas

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I think it depends on the payer, but for Medicare and most others, I think they follow the "half-way rule". This states that in order to qualify for a timed unit, you have to get halfway to that unit. So for your example, no the extra 1/2 hour would not be correct. Critical care guidelines pretty much lay that out for you. For the first hour, you would need at least 30 minutes, then for the additional half hour, you need 15 minutes beyond the first hour, or 75 minutes. This would be the same for "each 15 minutes" codes, like the PT codes. That's why the time scale is 8-22, 23-37, 38-53, etc., because those are the halfway marks between the 15 minute points. Make sense?
 

RainMaker

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Yes, that seems to be a reasonable heuristic in the absence of any written guidelines or parenthetical notes.

Thanks for your helpful response.

By the way, what exactly are those PT codes you refer to?
 

aaron.lucas

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You're welcome. The PT codes I mean are The Constant Attendance Modalities, and the Therapeutic Procedure codes, in the Physical Medicine section. 97XXX-series, they all say "each 15 minutes".
 

RainMaker

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Thanks again.

By the way, looking at the "Time" section in the introduction of the AMA's CPT 2012 Professional Edition, it does say "A unit of time is attained when the mid-point is passed."
I need to read the manual more thoroughly :)
 

aaron.lucas

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Not a problem. Yeah, I work sort of on the payer side of things (third party for auto insurance), and I see a lot of errors both with code selection and modifier usage that would never happen if 5 minutes were taken to read just a little more. No biggie though, glad I could help! :)
 
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