By Marty Kotlar, DC, CHCC, CBCS
Q: I often bill two to three time-based codes per visit. Do I have to spend at least eight or 15 minutes per procedure code in order to bill properly?
A: Unfortunately, the answer to this simple question is not simple. The best way to approach this is to first provide general recommendations and suggestions, and then give a few specific examples.
For any single-timed CPT code in the same day thats measured in 15-minute units, providers should bill a single, 15-minute unit for treatment greater than or equal to eight minutes through, and including, 22 minutes.
If the duration of a single procedure in a day is greater than or equal to 23 minutes, through and including 37 minutes, then two units should be billed.
Time intervals for one through four units are as follows:
One unit: eight minutes through 22 minutes,
Two units: 23 minutes through 37 minutes,
Three units: 38 minutes through 52 minutes, and
Four units: 53 minutes through 67 minutes.
If a service represented by a 15-minute timed code is performed in a single day for at least 15 minutes, that service should be billed for at least one unit. If the service is performed for at least 30 minutes, that service should be billed for at least two units, etc.
It is not appropriate to count all minutes of treatment in a day toward the units for one code if other services were performed for more than 15 minutes.
When more than one service represented by 15-minute timed codes is performed in a single day, the total number of minutes of service, as noted in the chart above, determines the number of timed units billed.
If any 15-minute timed service performed for seven minutes or less on the same day as another 15-minute timed service that was also performed for seven minutes or less, and the total time of the two is eight minutes or greater, then bill one unit for the service performed for the most minutes.
The same logic is applied when three or more different services are provided for seven minutes or less than seven minutes.
The expectation is that a providers direct patient contact time for each unit will average 15 minutes in length. If a provider has a consistent practice of billing less than 15 minutes for a unit, these situations could be
If more than one 15-minute timed CPT code is billed during a single calendar day, then the total number of timed units that can be billed is constrained by the total treatment minutes for that day. The amount of time for each specific modality or therapeutic procedure provided to the patient should be documented in the SOAP notes.
Eight minutes of therapeutic exercise (97110)
Eight minutes of manual therapy (97140)
Total: 16 timed minutes
The appropriate billing in this example is one unit. You should select 97110 or 97140 to bill since each unit was performed for the same amount of time and only one unit is allowed.
Seven minutes of neuromuscular re-education (97112)
Seven minutes of therapeutic exercise (97110)
Seven minutes of manual therapy (97140)
Total: 21 timed minutes
The appropriate billing in this example is one unit. You should select one code (97112, 97110, or 97140) to bill since each unit was performed for the same amount of time and only one unit/one code is allowed.
33 minutes of therapeutic exercise (97110)
Seven minutes of manual therapy (97140)
Total: 40 timed minutes
The appropriate billing in this example is three units. Bill two units of 97110 and one unit of 97140. Count the first 30 minutes of 97110 as two full units. Compare the remaining time for 97110 (33-30 = three minutes) to the time spent on 97140 (seven minutes) and bill the larger, which is 97140.
24 minutes of manual therapy (97140)
23 minutes of therapeutic exercise (97110)
Total: 47 timed minutes
The appropriate billing in this example is three units. Each of the codes is performed for more than 15 minutes, so each should be billed for at least one unit. The correct way to code this example is two units of 97140 and one unit of 97110, assigning more timed units to the service that took the most time.
18 minutes of therapeutic exercise (97110)
13 minutes of manual therapy (97140)
10 minutes of therapeutic activities (97530)
Eight minutes of ultrasound (97035)
Total: 49 timed minutes
The appropriate billing in this example is three units. Bill the procedures you spent the most time providing.
Bill one unit each of 97110, 97140, and 97530. Do not bill for the ultrasound because the total time of timed units that can be billed is constrained by the total timed code treatment minutes (i.e., you may not bill four units for less than 53 minutes regardless of how many services were performed). You should still document the ultrasound in the SOAP notes.
Marty Kotlar, DC, CHCC, CBCS is the president of Target Coding. Target Coding, in conjunction with Foot Levelers, offers continuing-education seminars on CPT coding and compliant documentation. He can be reached at 800-270-7044, email@example.com, or through www.TargetCoding.com.