Wiki Has anyone heard of Partial Billing Methodology that states only 1 minute of treatment is needed to bill 1 unit of a timed procedure, lets say 15 min?

Create Wiki
A

arielcosta

Contributor
Messages
19
Best answers
0
Has anyone heard of Partial Billing Methodology that states only 1 minute of treatment is needed to bill a unit of that procedure?

For example, this methodology would suggest that if a Physical Therapist performs treatment on a patient utilizing Neuromuscular Reeducation (CPT 97112) for a total of 5 minutes, 1 unit can be billed.

97112 is a 15 minute time code. Guidelines state 8 minutes are needed to bill a unit. Billing methodologies are unfamiliar to me; therefore, I'm wondering if anyone has been exposed to this methodology.
 
Last edited:
arielcosta said:
Has anyone heard of Partial Billing Methodology that states only 1 minute of treatment is needed to bill a unit of that procedure?

For example, this methodology would suggest that if a Physical Therapist performs treatment on a patient utilizing Neuromuscular Reeducation (CPT 97112) for a total of 5 minutes, 1 unit can be billed.

97112 is a 15 minute time code. Guidelines state 8 minutes are needed to bill a unit. Billing methodologies are unfamiliar to me; therefore, I'm wondering if anyone has been exposed to this methodology.
Click to expand...


Are there other services being billed with it on the same date of service?

If they are performing a service for 7 minutes or less on the same date that another service is performed for 7 minutes or less, you can combine the time and bill one unit for the service performed for the most minutes.

If you're providing only one service in a day, you should not bill for services performed less than 8 minutes.

This is direct from the Medicare Claims Processing Manual, Chapter 5 - Part B Outpatient Rehabilitation:



C. Counting Minutes for Timed Codes in 15 Minute Units
When only one service is provided in a day, providers should not bill for services performed for less than 8 minutes.

(chart not pasted - see the full document at the link above)

If any 15 minute timed service that is performed for 7 minutes or less than 7 minutes on the same day as another 15 minute timed service that was also performed for 7 minutes or less and the total time of the two is 8 minutes or greater than 8 minutes, then bill one unit for the service performed for the most minutes.

There are some specific examples given in the claims processing manual at the link above. I didn't paste all of the examples, but you can review them in the manual at the link above. It starts on roughly page 40 of the PDF.
 
sls314 said:
Are there other services being billed with it on the same date of service?

If they are performing a service for 7 minutes or less on the same date that another service is performed for 7 minutes or less, you can combine the time and bill one unit for the service performed for the most minutes.

If you're providing only one service in a day, you should not bill for services performed less than 8 minutes.

This is direct from the Medicare Claims Processing Manual, Chapter 5 - Part B Outpatient Rehabilitation:



C. Counting Minutes for Timed Codes in 15 Minute Units
When only one service is provided in a day, providers should not bill for services performed for less than 8 minutes.

(chart not pasted - see the full document at the link above)

If any 15 minute timed service that is performed for 7 minutes or less than 7 minutes on the same day as another 15 minute timed service that was also performed for 7 minutes or less and the total time of the two is 8 minutes or greater than 8 minutes, then bill one unit for the service performed for the most minutes.

There are some specific examples given in the claims processing manual at the link above. I didn't paste all of the examples, but you can review them in the manual at the link above. It starts on roughly page 40 of the PDF.
Click to expand...
Correct, CMS follows cumulative time billing methodology. I should have been more expansive in my question, my apologies. There is discussion currently within an organization of there being 3 billing methodologies: 1) would be the CMS "cumulative time" methodology, 2) would be "Substantial Portion" methodology which would be following coding guidelines of needing 8 minutes to bill 1 unit, and 3) is stating to be "Partial" methodology where only 1 minute is needed to bill a unit. I have never heard of this "Partial" billing methodology and so I was curious if anyone else has.
 
I have never heard of 'partial' billing methodology. I would look at the rules for the specific payer. For WA Workers Comp we base the units off the total time. So if 97112 was performed for 8 minutes and 97110 was performed for 10 minutes, then the total whould be 18 minutes, which equates to 1 unit of 97110 since the most time was spent performing it.
 
tmorgan808 said:
I have never heard of 'partial' billing methodology. I would look at the rules for the specific payer. For WA Workers Comp we base the units off the total time. So if 97112 was performed for 8 minutes and 97110 was performed for 10 minutes, then the total would be 18 minutes, which equates to 1 unit of 97110 since the most time was spent performing it.
Click to expand...
Thank you for your response. The methodology you describe aligns with CMS' approach. Yeah, I don't think the "partial billing" methodology is valid based on my research and communications. I was just curious if anyone else heard of this approach.
 
You must log in or register to reply here.
Top