Wiki Therapy Time Documentation of Individual Timed CPT (Not total time, in/out total session time or minute duration)

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amyjph

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Therapy auditors - does anyone have clear, official policy or guidelines (not Medicare) that clearly state a therapy provider must document the exact start and stop time (e.g. 8:00am-8:15am) for each individual procedure (timed CPT)? I am not talking about the time in/out of the session or the total minutes spent on each timed CPT.

For example if the provider documented the following (and had all other required documentation and flow sheet with exact activities performed. etc.) would you deny it (not Medicare) because there is no exact in/out time for every single CPT? 4 total units were billed on the claim for the timed 1:1 CPT (payer limits to 4 per day).

Time In: 4:00pm
Time Out: 5:10pm
Direct Minutes: 60
Treatment Minutes: 70
97110 ther ex 25 minutes (2 units billed)
97112 neuro re-ed 10 minutes (1 unit billed)
97530 ther activity 25 minutes (1 unit billed)
97010 hot/cold pack 10 minutes (1 unit) (documented not billed on claim)

In your opinion (or can you find a reference) that states "A session is equal to a unit of service for billing."?
Can you find an official reference that states (for physical medicine and rehab codes) that a session is a unit of time spent per CPT code and not the total visit of all services (procedures, activities, services)?

CPT Assistant: (Dec 2009, Volume 19, Issue 12, page 15) "Multiple units can be reported on a date of service for one or more procedures based on aggregate amount of time spent by a QHP in direct contact with the patient."

Thanks for any and all official reference you can provide on this. I'll take anything from a payer or state even if just for a reference to read but not cite if not applicable to state or plan.
Have you seen denials for this in working RCM? In past experience I remember getting denials from some commercial payers for this reason but could never find any firm reference that would back them up.
 
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Hey! Have you ever received a clear answer on this? There's been discussion lately regarding the meaning of "direct one-on-one." In other words, does this involve manual contact with the patient (strictly 1:1) or does verbal and visual contact time apply here.
 
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Unless the payor has their own guidelines CMS states use the '8 minute rule'. Which would be typical CPT rule of a unit is not allowed until half-way point is reached. We consider one-on-one time when the PT or PTA is working directly with the patient, visual and verbal cueing, but it has to be with that 1 patient. They can't be supervising another patient during that time, that would be group therapy, because you can't perform 2 one-on-one codes at the same time. For the example above 4 units would be correct. Start with intervention where the most time is spent then go to the next based off total time documented. We don't use in and out time because that includes non-timed services.
 
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This is from June 2019 CPT Assistant
Physical Medicine and Rehabilitation Question: A flexion/distraction table is used by the provider (one-on-one) to increase a patient’s range of motion (ROM) and flexibility while lowering the intrathecal pressure of the intervertebral disc for at least 8 minutes of face-to-face time. To achieve this, the patient’s ankles are strapped to the table, the table is then distracted, and, depending on the specific deficits identified during ROM tests, the patient is either placed passively into flexion or extension, with lateral flexion to the right or left, or rotation to the left or right, or a combination of both. When the passive ROM is being performed, manual pressure is applied at S1 while also applying pressure to the lumbar spine starting at L5 to L1. The process is then repeated in reverse order beginning at L1 and working to L5. The procedure is performed 2 to 3 times and typically takes 10 to 15 minutes total time. Should this be reported with code 97110?

Answer: No, it would be incorrect to report code 97110, Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility, for the procedure described. The correct code to report is 97140, Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes. In addition, this is a time-based code and for each 15 minutes of therapy, at least 8 minutes of face-to-face therapy must be provided to be able to report one unit. Manual therapy techniques include, but are not limited to, soft tissue mobilization; joint mobilization and manipulation; manual lymphatic drainage; manual traction; craniosacral therapy; myofascial release; and neural gliding techniques.
 
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