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Billing question on timed codes

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  • djgeisel
    When using a timed code, for instance one that specifies first 15 Min. and you are doing less that that, we append a 52 modifier. Is there anything that
    Message 1 of 4 , Mar 4, 2008
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      When using a timed code, for instance one that specifies "first 15
      Min." and you are doing less that that, we append a 52 modifier. Is
      there anything that specifies a minimum time that must be spent to use
      the code? This question was asked to me and I can't find anything on
      that. Thanks for your help. Diana
    • B Burgess
      I think that may be a payor specific issue. For Medicare, it is at least 8 minutes up to 23 minutes. CPT Assistant Aug 2005 states in
      Message 2 of 4 , Mar 4, 2008
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        I think that may be a payor specific issue. For Medicare, it is at least 8 minutes up to 23 minutes.

        CPT Assistant Aug 2005 states in part.....................

        Several CPT codes used for therapy modalities, procedures, and tests and measurements specify that the direct (one-on-one) time spent in patient contact is 15 minutes. Providers report procedure codes for services delivered on any calendar day using CPT codes and the appropriate number of units of service. Under Medicare, for any single CPT code, providers bill a single 15-minute unit for treatment greater than or equal to 8 minutes and less than 23 minutes.
        If the duration of a single modality or procedure is greater than or equal to 23 minutes to
        less than 38 minutes, then 2 units should be billed. Time intervals for larger numbers of units
        are as follows:
        Units Reported on the Claim Number Minutes
        3 units > 38 minutes to < 53 minutes
        4 units > 53 minutes to < 68 minutes
        5 units > 68 minutes to < 83 minutes
        6 units > 83 minutes to < 98 minutes
        7 units > 98 minutes to < 113 minutes
        8 units > 113 minutes to < 128 minutes

        Does this help ?

        Barbara Burgess, RN, CPC, ACS-EM, PCS


        djgeisel <djgeisel@...> wrote:
        When using a timed code, for instance one that specifies "first 15
        Min." and you are doing less that that, we append a 52 modifier. Is
        there anything that specifies a minimum time that must be spent to use
        the code? This question was asked to me and I can't find anything on
        that. Thanks for your help. Diana






        ---------------------------------
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        [Non-text portions of this message have been removed]
      • djgeisel
        Thank you. So at least for Medicare, you are saying you must do the service for at least 8 min to use a timed code which states first 15 min. in it s
        Message 3 of 4 , Mar 5, 2008
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          Thank you. So at least for Medicare, you are saying you must do the
          service for at least 8 min to use a timed code which states first 15
          min. in it's description. And if you attach a 52 modifier that tells
          them that you did the 8 min minimum? Plans that are not specific
          about a minimum time do not require you to at least 8 min. Am I
          understanding that right? Thank you for your help. Diana

          --- In MedicalBillers@yahoogroups.com, B Burgess <granbfly@...> wrote:
          >
          > I think that may be a payor specific issue. For Medicare, it is at
          least 8 minutes up to 23 minutes.
          >
          > CPT Assistant Aug 2005 states in part.....................
          >
          > Several CPT codes used for therapy modalities, procedures, and
          tests and measurements specify that the direct (one-on-one) time
          spent in patient contact is 15 minutes. Providers report procedure
          codes for services delivered on any calendar day using CPT codes and
          the appropriate number of units of service. Under Medicare, for any
          single CPT code, providers bill a single 15-minute unit for treatment
          greater than or equal to 8 minutes and less than 23 minutes.
          > If the duration of a single modality or procedure is greater than
          or equal to 23 minutes to
          > less than 38 minutes, then 2 units should be billed. Time
          intervals for larger numbers of units
          > are as follows:
          > Units Reported on the Claim Number Minutes
          > 3 units > 38 minutes to < 53 minutes
          > 4 units > 53 minutes to < 68 minutes
          > 5 units > 68 minutes to < 83 minutes
          > 6 units > 83 minutes to < 98 minutes
          > 7 units > 98 minutes to < 113 minutes
          > 8 units > 113 minutes to < 128 minutes
          >
          > Does this help ?
          >
          > Barbara Burgess, RN, CPC, ACS-EM, PCS
          >
          >
          > djgeisel <djgeisel@...> wrote:
          > When using a timed code, for instance one that
          specifies "first 15
          > Min." and you are doing less that that, we append a 52 modifier. Is
          > there anything that specifies a minimum time that must be spent to
          use
          > the code? This question was asked to me and I can't find anything
          on
          > that. Thanks for your help. Diana
          >
          >
          >
          >
          >
          >
          > ---------------------------------
          > Be a better friend, newshound, and know-it-all with Yahoo! Mobile.
          Try it now.
          >
          > [Non-text portions of this message have been removed]
          >
        • B Burgess
          I think I would interpret that as saying you do not need the 52 mod on a m care claim if the service was provided for 8 to 23 minutes and as long as it was at
          Message 4 of 4 , Mar 5, 2008
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            I think I would interpret that as saying you do not need the 52 mod on a m'care claim if the service was provided for 8 to 23 minutes and as long as it was at least 8 minutes they will pay. If it was less than 8 minutes and the code states 15, then it may not be billable to m'care at all.......... but I can't say for sure. For other carriers, you may want to check with each one individually and if nothing definitive is stated then yes, I would use the 52 for less than 15 minutes. We also looked at BC/BS of Alabama guidelines for billing timed PT services, and it just stated "Special care should be given in reporting and documenting these services" and where there were time based codes referenced it said "each 15 minutes". It didn't say one way or another about using the 52 mod, but since that is a CPT rule and BC/BS doesn't say not to use it, then I would.

            I don't have any first hand experience with actually billing these codes or looking at rejections, this topic just happened to recently come up in our office when we were looking at some physical therapy services. We were looking into it from a documentation requirement standpoint though, and not at individual claims or what they paid.

            Barbara

            djgeisel <djgeisel@...> wrote:
            Thank you. So at least for Medicare, you are saying you must do the
            service for at least 8 min to use a timed code which states first 15
            min. in it's description. And if you attach a 52 modifier that tells
            them that you did the 8 min minimum? Plans that are not specific
            about a minimum time do not require you to at least 8 min. Am I
            understanding that right? Thank you for your help. Diana

            --- In MedicalBillers@yahoogroups.com, B Burgess <granbfly@...> wrote:
            >
            > I think that may be a payor specific issue. For Medicare, it is at
            least 8 minutes up to 23 minutes.
            >
            > CPT Assistant Aug 2005 states in part.....................
            >
            > Several CPT codes used for therapy modalities, procedures, and
            tests and measurements specify that the direct (one-on-one) time
            spent in patient contact is 15 minutes. Providers report procedure
            codes for services delivered on any calendar day using CPT codes and
            the appropriate number of units of service. Under Medicare, for any
            single CPT code, providers bill a single 15-minute unit for treatment
            greater than or equal to 8 minutes and less than 23 minutes.
            > If the duration of a single modality or procedure is greater than
            or equal to 23 minutes to
            > less than 38 minutes, then 2 units should be billed. Time
            intervals for larger numbers of units
            > are as follows:
            > Units Reported on the Claim Number Minutes
            > 3 units > 38 minutes to < 53 minutes
            > 4 units > 53 minutes to < 68 minutes
            > 5 units > 68 minutes to < 83 minutes
            > 6 units > 83 minutes to < 98 minutes
            > 7 units > 98 minutes to < 113 minutes
            > 8 units > 113 minutes to < 128 minutes
            >
            > Does this help ?
            >
            > Barbara Burgess, RN, CPC, ACS-EM, PCS
            >
            >
            > djgeisel <djgeisel@...> wrote:
            > When using a timed code, for instance one that
            specifies "first 15
            > Min." and you are doing less that that, we append a 52 modifier. Is
            > there anything that specifies a minimum time that must be spent to
            use
            > the code? This question was asked to me and I can't find anything
            on
            > that. Thanks for your help. Diana
            >
            >
            >
            >
            >
            >
            > ---------------------------------
            > Be a better friend, newshound, and know-it-all with Yahoo! Mobile.
            Try it now.
            >
            > [Non-text portions of this message have been removed]
            >






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