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

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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