I review a LOT of chiropractic records, and even some physical therapy records. One mistake I see happening pretty frequently is the use of timed modalities
Several CPT codes specify that direct (one-on-one) time spent with the patient is 15 minutes.
We get that.
Services provided for a single timed CPT code that is less than 8 minutes should not be billed. You still have to document it, but you just can’t bill for it. And if you’re thinking about using the 52 modifier for reduced time…
Forget about it.
The 52 modifier is no longer used for reduced time.
When more than one service represented by 15 minute timed codes is performed in a single day, the total number of minutes of service determines the number of timed units billed.
Here’s a chart that provides time intervals for billing units based on treatment time in minutes:
The next thing to know is that you have to document the specific number of minutes, not the range. In other words, you have to document “12 minutes,” not “8-22 minutes.”
So, let’s say you perform 8 minutes of Ultrasound, 8 minutes of manual therapy (to a different area than was adjusted) and 18 minutes of therapeutic exercises. Many doctors and physical therapists are billing for 3 units, but that would be wrong. Add up the minutes and you get 34 minutes. Look at the chart above and you see that 34 minutes is considered 2 units.
Make sure your billing software and your billing person understands this. Otherwise, this can cause problems.