We recently added a fee slip to my EMR. The non-time-based codes are pretty straightforward, but there are a few things you may or may not be aware of. For those of you who use a Spinalator table, it can no longer be billed with CPT code 97012 (mechanical traction). The appropriate code for this is now 97039 (unlisted modality).
Here's an oldie, but goodie - flexion/distraction is considered to be a type of CMT, not mechanical traction.
The biggie, though, is billing time-based codes. These are procedures that are described with "each 15 minutes," or something similar. Examples include ultrasound, manual therapy and therapeutic exercise. Most billing programs are set up so that the user enters the charges, so if you did 8 minutes of ultrasound, 12 minutes of manual therapy and 12 minutes of therapeutic exercise, you'd be billing for all 3 modalities.
But that would be wrong.
The rule is, we've got to add the TOTAL number of minutes for ALL time-based procedures, and THEN determine the total number of units. In the example above, the three procedures add up to a total of 32 minutes, which is considered only two units (23-37 minutes). One of those procedures would not be billable.
When we decided to create the fee slip in my EMR, I wanted it to be accurate. I explained the rules to my programmer, and she spent a crazy amount of time and energy dealing with the logic and coding. So when a fee slip is created, it's created directly from your documentation and the program calculates how many units are billable for the time-based codes. It even gives you a brief explanation as to why a certain code didn't make the cut on the fee slip.
This is important to anyone who bills insurance, in particular. Since most of the time you won’t be asked for records, you might be getting paid just fine, even when billing for these codes incorrectly. But if you’re ever audited, like Wellmark BCBS has been doing quite a bit of in the Midwest lately, you may end up paying back a LOT of money.
Make sure you are documenting and billing correctly from the start, and all should be good.