by Marty Kotlar, DC, CPCO, CBCS •
President of Target Coding •
Is it Possible to Bill for 6 units of therapy in one hour?
The simple answer is YES. Let’s begin with 5 units in one hour. Here’s the scenario:
- Patient A arrives at 8:00 am and then 25 minutes of direct one-on-one patient contact consisting of manual therapy is provided (from 8:00 am to 8:25 am). Billing is 97140 for 2 units.
- Patient B arrives at 8:15 am and is set up on mechanical traction (by a qualified staff member) for 10 minutes (supervised modality, untimed) and then 24 minutes of direct one-on-one patient contact consisting of therapeutic exercise is provided by the DC (from 8:26 am to 8:50 am). Billing is 97110 for 2 units and 97012 for 1 unit.
- Patient C arrives at 8:45 am and then 9 minutes of direct one-on-one patient contact consisting of neuromuscular reeducation is provided by the DC (from 8:51 am to 9:00 am). Billing is 97112 for 1 unit.
- Summary: 8:00 am to 9:00 am, 5 timed units & 1 untimed code can be billed in 1 hour with 1 DC.
Here’s the scenario for 6 units in one hour:
- Patient A arrives at 8:00 am and 8 minutes of direct one-on-one patient contact consisting of therapeutic exercises is provided (from 8:00 am to 8:08 am). Billing is 97110 for 1 unit.
- Patient B arrives at 8:05 am and then 10 minutes of direct one-on-one patient contact consisting of therapeutic activities is provided by the DC (from 8:10 am to 8:20 am). Billing is 97530 for 1 unit.
- Patient C arrives at 8:10 am and then 9 minutes of direct one-on-one patient contact consisting of manual therapy is provided by the DC (from 8:15 am to 8:24 am). Billing is 97140 for 1 unit.
- Patient D arrives at 8:15 am and 8 minutes of direct one-on-one patient contact consisting of neuromuscular reeducation is provided by the DC (from 8:25 am to 8:33 am). Billing is 97112 for 1 unit.
- Patient E arrives at 8:20 am and then 10 minutes of direct one-on-one patient contact consisting of gait training is provided by the DC (from 8:35 am to 8:45 am). Billing is 97116 for 1 unit.
- Patient F arrives at 8:45 am and then 10 minutes of direct one-on-one patient contact consisting of manual therapy is provided by the DC (from 8:48 am to 8:58 am). Billing is 97140 for 1 unit.
- Summary: 8:00 am to 9:00 am, 6 timed units can be billed in 1 hour with 1 DC.
These clinical examples with this type of patient flow are not easy to accomplish, however it is possible.
Dr. Marty Kotlar is the President of Target Coding. Over the last 12 years, he has helped hundreds of chiropractors, physical therapists, and acupuncturists with compliance as it relates to billing, coding, documentation, Medicare & HIPAA. Dr. Kotlar is certified in compliance, a certified coding specialist, a contributing author to many coding and compliance journals, and a guest speaker at many state association conventions. He can be reached at 1-800-270-7044, website – www.TargetCoding.com, email – drkotlar@targetcoding.com. Click the link below to schedule a FREE 15-minute consultation with Dr. Kotlar: https://go.oncehub.com/DrKotlar
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Why is the Discount Challenge prize amount $15,024? Because that is the average “per-occurrence” fine for Medicare inducements. That’s not $15,024 per patient, that’s not per provider, that’s PER VISIT. Stinks, doesn’t it? To us, the prize amount is worth the investment if we can help our profession better understand proper discounting.