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Diabetes counseling 45 mintues

  1. #1
    Default Diabetes counseling 45 mintues
    Exam Training Packages
    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!

  2. #2
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    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.

  3. #3
    Location
    Columbia, MO
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    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 A. Mitchell, MSPH, CPC-H

  4. #4
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    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?
    Last edited by efrohna; 09-17-2009 at 10:45 AM.
    Evangelina Frohna, CPC, CEMC

  5. #5
    Location
    Columbia, MO
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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.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
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    Thank you Debra!
    Evangelina Frohna, CPC, CEMC

  7. #7
    Location
    Milwaukee and Madison
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    Where can I find information on 45 minutes being allowed to be billed as 2 units for CPT 98960? I believe Debra Mitchell posted on this earlier. Thanks.......

  8. #8
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    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.

    Debra A. Mitchell, MSPH, CPC-H

  9. #9
    Default Reference
    Chapter 12. Section 30.6.15.1

  10. #10
    Location
    Milwaukee and Madison
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    Default 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?

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