Let's Help Each Other

Physical therapy is changing rapidly. As a PT with more than thirty years of experience, the changes observed in the last ten years triple those of the first twenty years. The pace of change is not slowing down. The Medigraph Blog will serve as a forum that will enable us to exchange ideas and assist each other. This blog will be used to share billing, documentation, and any other ideas to improve any aspects of our profession. If we share what we have learned, we can develop a resource that enables our collective understanding to advance our careers.

As profit margins grow smaller and expenses grow larger, we need to assist each other to survive and prosper. If we share our experiences we can help each other to grow professionally, administratively, and financially. Our professional lives, our livelihood, and our personal lives are intertwined. Our resources individually are limited. Together we can accomplish more than we can individually. Let's help each other


Tom Kane, PT
MediGraph Software

Timed Codes and Audit Triggers
4/17/2011 6:18:00 PM

A frequent trigger for  RAC audits are time code violations, especially un-timed codes.  CMS documentation requirements call for a daily therapy note to include the recording of minutes in timed codes as well as total minutes of therapy.  Unfortunately, many private insurance providers are beginning to employ the same standards.  To avoid triggering an audit your billing minutes and your documentation minutes must coincide, which will prevent  RAC computer data mining triggers.  When performing your documentation, use the time recorder “Time in Time Out” utility in MediGraph to document and collaborate your intervention and charges.  The following information is an example of how to coordinate your clinical and administrative efforts to maximize revenue while simultaneously providing quality treatment.

Counting Minutes for Timed Codes in 15 Minute Units and the Eight Minute RuleTimed codes are subject to the Medicare "Eight-minute rule," and the total number of billed units is limited by the total minutes in timed codes.  These confusing standards often trigger RAC audits because of conflicts between documentation and billing.The eight-minute rule applies to any timed CPT code, which is  measured as a 15 minute unit.   Therapists can bill a single 15-minute unit for treatment greater than or equal to 8 minutes through and including 22 minutes. If the duration of a single modality or procedure in a day is greater than or equal to 23 minutes through and including 37 minutes, then 2 units should be billed. Time intervals for 1 through 8 units are as follows:

1 unit: ≥ 8 minutes through 22 minutes
2 units: ≥ 23 minutes through 37 minutes
3 units: ≥ 38 minutes through 52 minutes
4 units: ≥ 53 minutes through 67 minutes
5 units: ≥ 68 minutes through 82 minutes
6 units: ≥ 83 minutes through 97 minutes
7 units: ≥ 98 minutes through 112 minutes
8 units:≥ 113 minutes through 127 minutes

An example of  timed code confusion is billing for ultrasound.  If an ultrasound procedure is less than eight minutes, it is not billed directly.  Instead, because those minutes are rolled into the total minutes in timed codes, the result is an additional unit of another code being billed.   It may be simpler to bill for 8 minutes of ultrasound, which can easily be accomplished by providing 5 minutes of continuous ultrasound to elevate tissue temperature, followed by three minutes of pulsed ultrasound to gain the benefits of the mechanical effects of ultrasound.  CMS provides guidance on the "eight-minute rule" in Chapter 5 of the Medicare Claims Processing Manual.  http://www.cms.gov/manuals/downloads/clm104c05.pdf, pg. 24.

Un-timed Codes Un-timed codes are a favorite target of RACs and are responsible for a large number of audits.  It is important to understand that un-timed codes can only be billed for one (1) unit of service regardless of the actual time spent on a therapy encounter. For example, a therapy evaluation that takes 15, 30, or 60 minutes may be billed for one unit.  There is no prohibition  (CMS Transmittal 1019, which since has been incorporated into the Medicare Claims Processing Manual) against billing two separate and distinct un-timed codes; for example a physical therapy evaluation on the same day as a speech-language pathology evaluation.  For more info on untimed codes see Page 13 at:



Tom Kane, PT
MediGraph Software

CPT Codes and Equipment Purchases. Costs vs. Benefits
4/5/2011 6:08:00 PM
I received a call from a  MediGraph subscriber that may be of  benefit to other subscribers.  The MediGraph subscriber with whom I spoke was discussing purchasing an expensive piece of equipment to perform therapeutic exercise, and asked if I had ever used this type of tool.   I had experience with the equipment and did not recommend the purchase.  Allow me to explain.
CPT codes help to identify the interventions that we provide to our patients,   standardizing and facilitating the billing process for insurance providers.    A fact that often goes unrecognized is that CPT codes also control costs.  Despite the use of modifiers and other administrative-billing adjustments, there is  limited reimbursement  that one will receive for a specific CPT code.  This fact should influence your equipment purchasing decisions, because CPT codes restrict  reimbursement,  regardless of the equipment employed.    For example, let us assume that CPT 97110  (therapeutic exercise) receives a hypothetical maximum reimbursement of $35.   If we employ a piece  that costs $35,000, a therapist would have to perform 1,000 visits on that piece of equipment prior to breaking even on this expenditure.   I understand that the long view would suggest that the equipment would supposedly be adding to the revenue stream after 1,000 patients have use that item but one must ask if there are effective alternatives.  For example,  an entire circuit of Nautilus or Keiser, etc. can be purchased for the cost of one piece of exotic equipment ($35,000),  If code 97110 does not distinguish payment between the exotic and the less esoteric, and the benefits to the exotic are , at best marginal (if any), the cost benefit, return on investment that is restricted by CPT coded payment must be a consideration when purchasing equipment.
Tom Kane, PT
MediGraph Software