Wiki 97802/97803 Billing with 1/2 units

[rogers]

Is there anyone out there who is currently billing for a RD billing in 1/2 units when the encounter doesn't meet the second or third full 15 minutes? For example, the visit would last 40 minutes, which is over the 30 minute visit, (2units) and additionally 8 minutes over the CPT guidelines of 15 minutes of face to face time, thus allowing for an additional 1/2 unit. I have a RD who is asking if this is a billable situation, but I can't find anything in my research. I am hesitant to bill out in this manner. Any thoughts are greatly appreciated.

 

[mitchellde]

the way the timing works for the 15 minute codes is:
8 - 22 minutes =1 unit
23 - 37 =2 units
38 - 52 = 3 units
and so on

 

[emily.cooper]

Question

the way the timing works for the 15 minute codes is:
8 - 22 minutes =1 unit
23 - 37 =2 units
38 - 52 = 3 units
and so on

Mitchellde,

Can you provide your resource for the time ranges above? Thank you in adance.

Emily Cooper, CPC, CPMA, CFPC

 

[CodingKing]

Here is some information from CMS. Its called the rule of 8's. Unless otherwise specified you need to make it 50% into the specified time in the code to bill

Medicare Claims Processing Manual, chapter 5, 20.2.C

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c05.pdf