Using Timed Therapy Codes Appropriately
In chiropractic care, accurate and appropriate use of timed therapy codes is essential for ensuring compliance with federal regulations and avoiding legal pitfalls. Recent legal actions against The Grand Health Care System and its affiliates highlight the importance of understanding and correctly applying these codes. Here’s a detailed look into how chiropractic physicians can use timed therapy codes appropriately and avoid common mistakes.
The Importance of Timed Therapy Codes
Timed therapy codes are used to bill for services based on direct, one-on-one patient care duration. Common codes include those for manual therapy, therapeutic exercises, and other skilled rehabilitation services. Medicare’s “eight-minute rule” is a crucial guideline for determining the billable units of service.
The Eight-Minute Rule
For time-based codes, Medicare requires a minimum of eight minutes of direct patient care to bill for one unit of service. The total time spent on therapy is divided by 15 to determine the number of billable units. An additional unit can be billed if eight or more minutes remain after dividing. (Collins, 2016)
For instance:
1 unit: 8-22 minutes
2 units: 23-37 minutes
3 units: 38-52 minutes
4 units: 53-67 minutes
Commonly used codes in chiropractic practices include:
97110: Therapeutic exercises
97112: Neuromuscular re-education
97124: Massage therapy
97140: Manual therapy techniques
Each code requires accurate documentation of the time spent on each procedure to ensure compliance and proper reimbursement.
Proper Documentation
To maximize revenue and avoid legal issues, chiropractors must:
Clearly Document Techniques and Time: Record the specific techniques, therapeutic goals, and time spent on each procedure. Documentation should reflect direct, face-to-face time with the patient, including pre-service, intra-service, and post-service activities. (Kathleen D. Weissberg, 2018)
Accurately Calculate Total Time: The total time is cumulative when multiple services are provided. For example, if you provide 10 minutes of therapeutic exercise (97110) and 10 minutes of manual therapy (97140), you have 20 minutes. This time only qualifies for one unit, which falls below the 23-minute threshold for two units.
Ensure Consistency with Clinical Condition: Therapy services should be based on the individual patient’s clinical needs, not arbitrary quotas, or financial incentives. Overbilling or providing unnecessary services can lead to severe penalties, as seen in the Grand Health Care System case.
Examples of Proper Billing
Example 1:
24 minutes of neuromuscular re-education (97112)
23 minutes of therapeutic exercise (97110)
Total time: 47 minutes
This falls within the range for three units (38-52 minutes). The correct coding would be two units of 97112 and one unit of 97110. You are required to assign more units to the service that took the most time.
Example 2:
20 minutes of neuromuscular reeducation (97112)
20 minutes therapeutic exercise (97110)
Total time: 40 minutes
Appropriate billing for 40 minutes is 3 units. Each service was done at least 15 minutes and should be billed for at least one unit, but the total allows 3 units. Since the time for each service is the same, choose either single code (97112 or 97110) for 2 units and bill the other for 1 unit. When the times are equal, you may choose to assign more units to the service that has a greater value.
Timed therapy codes are critical for compliance and ethical practice in chiropractic care. By understanding and applying the eight-minute rule, accurately documenting services, and ensuring that therapy is clinically justified, chiropractic physicians can avoid the pitfalls that led to legal action against The Grand Health Care System. Always prioritize patient needs over financial incentives to uphold the integrity of your practice and protect your patients.
