Network Policies – Timed Therapy Codes

Timed therapy codes have specific rules for how to calculate the treatment time. This week we provide details on these calculations and how to properly bill. Watch the video to learn more!

Transcript:

Last week, we began to talk about the importance of looking at specific medical policies for the networks, for the insurers to which you are contracted. In other words, you want to make sure that you’re familiar so that you’re following the rules that they lay out and the importance thereof. We talked about some specific provisions within the Blue Cross Blue Shield medical policy for chiropractic services, specifically, briefly spoke about the importance of documenting even the specific technique used on the region that you are adjusting and documenting. So you wanna make sure you document that. That was last week.

Advertisement

This week, I want to talk about timed therapy codes, there is a fairly lengthy section on timed therapy codes. There are specific rules in regard to how to calculate that time. One of the biggest things is I want to make sure that, you know, you actually have to document the exact modality that you’re utilizing. So some of the CPT codes for example, 97140, is fairly broad, there’s a number of different things that can fit within that particular CPT, so make sure that you document exactly what modality and how you’re delivering that care. How does the time therapy portion timecode work? And what do they require?

First of all, I want to make sure it’s clear, there are a couple of different references to this. But you want to make sure that you actually document both the start time and the end time and the total time that was spent on this particular timed therapy code. It does require according to their medical policy, both a start time and an end time. Now after that, what does that really look like? How many units can you bill? I think is based on the eight-minute rule. Although in the past, there was a lot of combination that would happen in regard to time therapy codes, and determining exactly which code to bill and how to bill those codes. The way that their policy lays all of this out, is actually every code is different. So that you would begin the time over for each different timed therapy code. So you would not combine and then find the most appropriate timeframe.

Now how does the 8-minute rule work? At least according to their medical policy, you want to make sure that you follow that in the BlueCross BlueShield medical policy for chiropractic services, when they talk about time therapy codes, it is eight minutes. So the very minimum time is eight minutes, if you are delivering a particular modality that is a time therapy code for less than eight minutes, and you’re not able to bill that code, it’s not billable. You must again document the start time, the end time, and the total time that’s less than eight minutes, then you cannot build for that particular service. After that point, everything works on the rules of eight. So eight, all the way through 22 minutes, then, would be a single unit. And then from 23 minutes up to, say 37 minutes again, working on those rounded 15-minute timeframes. So 15 minutes plus eight minutes would draw you into that next unit. And that’s the 23-minute mark, right? Also, 30 minutes with another eight minutes is 38 minutes will draw you into the third unit of time therapy for that particular individual CPT code that requires time. So that’s really important.

Now what else is critical – there are another couple of things that are critical. One is rest time. So if there’s rest time in between a particular time therapy code, that does not count towards the calculation of time for that particular code. Additionally, and this is really important, they’re not including the setup and teardown time. So it takes a little while to get the patient prepared to be able to receive the treatment or the modality that you’re utilizing. That time doesn’t count if it takes a little bit of time to finish after the completion, that is also not counted. The only time is the actual time delivering the service for that timed therapy code. All of those things are critical. They lay out all of those again, and their medical policy will relink that in this particular video. But again, this is really important. This is how BlueCross BlueShield handles the time therapy codes. We encourage you all to review the medical policies for each one of the carriers to which you are in network with so make sure that you review all of those. Hopefully, it’s helped you out and we’ll catch you next week.