Blog, Chirosecure Live Event June 12, 2022

Timed Therapies – What You Have To Know

YouTube player

Click here to download the transcript.

Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.  We suggest you watch the video while reading the transcript.

Hi, welcome back everyone. This is Sam Collins, your coding and billing expert for chiropractic and the HJ Ross Company coming to you with ChiroSecure for let’s grow your practice. Let’s make sure we can do it without some risk as well. One of the issues that I commonly get, I get this question all the time.

Do any continuing education and during our network services. How do I properly document time? How do I account for it? Cause I want to make sure I’m getting paid and that’s really the end of the day. That’s what I want to focus on. What I want to do today is kind of audit how you’re doing your documentation for time services and understanding it to make sure you’re getting the maximum reimbursement, because you will know the better we are compliant.

The better you can get your reimbursement. And that at the end of the day is still what you are. You are a business, you’re a healthcare provider, of course. And that’s our number one, but you also have to be paid for what you do. And often a lack of understanding of these codes creates a lot of lost revenue.

So let’s go to the slides, everyone. Let’s talk about what’s going on. How do we understand timed services? In fact, I want a little bit fast here, so let me come back. So this is going to be on time physical medicine services. Physical therapy, physical medicine, and let’s understand these codes are not owned by physical therapists.

So they would make it seem like they are, they are physical medicine services that you may do within your scope. So these services you’ll see here, we start with our modalities and the modalities or things. We apply to it. But it’s doing the work for us. Now, some of these modalities, though, you’ll see hearsay supervised, which simply means you can put it on it and not have to be there like a hot lamp or something.

Turn it on, let the patient relax, but then there’s other ones. And this is the emphasis. Today is on constant attendance or time services. And you’ll notice constant attendance indicates a time with each of them notice 15 minutes for each every time. There’s a time therapeutic intervention. When it comes to therapies, they’re always in 15 minutes now.

Supervised has no. But the constant attendance do have a time. And the reason, and the difference of this is a constant attendance means you have to be there for it to work. By example, an ultrasound. If you were to leave the room, obviously the ultrasound would stop working. So therefore it requires constant attendance.

As a consequence we can build in units based on the amount of time. And the whole point of it is to make sure that you get paid the proper amount for the work that you do much like a 15 minute. Well, it will be different in price from a 30 minute or an hour. It’s saying here with any of these services as well.

This also includes however, therapeutic procedures and these are going to be kind of. Hands-on things often you’re like massage, but also could be exercise. And I like to point out that these indicate that you have to have direct one-on-one contact with the patient. And people often think does contact me.

I have to be touching the patient. And the answer to that is actually, no, they classify that as time to run time and on time units may be built based on the data service and the patient, you know, either you do it or. You get one unit, but time services may be built for multiple times or multiple units within a day, based on the amount of time that you’re spent providing the service to the patient.

And so you’ll hear the term one-on-one contact are often face-to-face. So that means you’re basically in the room providing a component of the service. It doesn’t necessarily mean you have to touch them. By example, if you’re doing a, let’s say extra stuff, Would it require that you be touching the patient, if you will, as they’re doing it now, now what may have some times where you’re assisting, but keep in mind, it doesn’t mean touching, but means that you’re in the room.

So from a CPT coding perspective, and this is from the CPT manual therapy, therapeutic procedure, one or more regions, each 15 minutes requires the therapist to maintain direct contact with the patient. Now, what do they consider direct visual? Verbal and or manual contact. So any of those, and that comes from the CPT assistant dating all the way back to December of 99.

Now, remember the context says it must be sufficiently skilled to assure that the procedure will cause the intendant specific therapeutic benefit or change, you know, simply watching someone do an exercise incorrectly would not be. Sufficient. Now notice how the states that watching them do an exercise incorrectly.

Obviously if you’re having someone do exercise, rehabbing your office, my goodness. Even if it’s a staff under supervision, they can’t just watch and go, okay, you’re finished. They’re going to be assisting them, making sure they’re doing it correctly, making sure they’re doing it through a full range.

Making sure that intended therapeutic benefit will be there. But again, it doesn’t mean you have to touch, but a lot of people run into, well, what is this time constituted? It says 15 minutes. What does it include? Whereas your wellbeing. And chiropractic when you do a manipulation, there’s a little bit of pre-service work that’s associated.

Well, the same applies with therapy. So it doesn’t mean exactly once you start, like, okay, ready go. But there’s a little bit of pre-service work too. Ready for the service. In other words, doing some evaluation, it doesn’t mean simply getting the patient ready, like, oh, go in the room and get on a gown. But it means doing something directly.

Of course there is beyond the pre-service interest service interest service refers to the actual hands-on, if you will, or facing. Treatment time, but remember, there’s a little bit of post-service to the post services after the assessment, maybe you’ve done an ultrasound and then you’re looking afterwards, making sure there’s no erythemia things of that nature that would count.

So it’s not just the time that it’s on now. Let’s be careful. Let’s not equate, you know, five minutes of pre-service and five minutes of post-service. I think that’s a little exaggerated, but at least it allows you to know within that it is included to an extent, and even including up to the documentation, assuming the patient is.

But here’s our problem as a profession. I’m not sure if many of you know, but I’m part of the United healthcare. Coding and reimbursement committee. Now it’s an appointed position. I don’t work for the insurer, but once a year, one of the meetings we have goes over where chiropractic has issues with documentation, and you can see her dating back all the way from 2014, the biggest area, we have problems as a profession and where we run into the most problem with audits.

Is not properly documenting time. You’ll notice there was a time it was 70%, 33, it got better. And it’s a little better, 22. And even this past year, I just got the new notice. It’s about the same. So about a quarter of the time, we have a problem in our profession that if you’re documenting time services, chances are one in four of you.

If you’re audited are going to have to pay that money back, I want to make sure that doesn’t happen because this is not as complicated as it may seem once we understand the parameters. So we have a 15 minutes. But does that mean I have to spend 15 minutes actually, not according to CMS. And everyone has adopted that for the most part is the eight minute rule.

And the eight minute rule dictates. So, so long as you spend at least eight minutes of the 15 minutes, you may bill for the service now, frankly, that’s not very hard. I think you probably all already knew that and you go see him. You’re not helping with anything new, but bear with me here. Let’s talk about this.

One unit can be as little as eight minutes. That’s very true. But what about a second year? I have to do eight minutes into the second unit. That’s why you’ll notice two units is 23 minutes. So it’s not as simple as eight and eight, but it has to be 15 plus eight. Notice that same pattern goes that three units is 30 plus eight or 38 minutes, four units, 45 plus eight or 53.

And this pattern continues the same in excess of an hour. So I don’t think we typically do much more than that. Now do keep in mind, you can only have one time to base code at a time. Now by example, could I be doing infrared heat while the person is getting massage or manual therapy? Oh, sure. It’d be a different area, but you can’t do two hands on stairs.

You can’t say. Okay. On one hand, I’m exercising. On the other hand, I’m doing massage that we can’t do because they’re one at a time. However, this is where I want to kind of bring up kind of this analogy. We’ve all been to Ikea and you ever see those instructions. And here’s my statement to it. The guidelines for using eight minute rule are kind of like instructions for building a piece of furniture from Ikea.

They appear simple at first, but before you know it you’ve been struggling for hours, you’re putting it together. You get a lopsided desk, you have seven leftover screws. You have some other dowels things left on the floor. And the thing is. Well, maybe those are just extras right now being a little facetious, but to say, let’s make sure we have a clear understanding because once you do, it’s not hard.

And this comes from the cumulative time nature of it. And this is where I often see problems. A provider will do two different services for time and they don’t understand it’s cumulative. So it says. If more than one procedure code is billed for the same data service, then in order to fully support all of the build services, that time must be separately documented for each so that we know how much time was spent on service one and service two.

That way we’ll clearly document what portion of the total visits was spent performing each of the build services, because in a way you have to remember the time is still going to be cumulative. So here’s an example. Now based on the eight minute rule, what might you think we could bill for this? Do you think, Hey, wait, we can build one unit of each service.

Well, before we go there, let’s total this up. If you spent 20 minutes, is that enough for two years? It is not, you may have one unit of, one of the services may be billed and it may be the higher value. Like I would certainly pick exercise over massage because the higher value, but I cannot build both because I did not have enough time cumulatively.

So even though it’s two different services to meet two units, regardless of same service or different services, you have to hit 23 minutes. So here’s another example. Same, sorry. But in this service you document, you spent 12 minutes and 11 minutes. Well that’s 23 minutes. Would I be able to build one unit of each service?

Absolutely. So it becomes imperative to really be good about documenting how much time be careful of giving what I call average times like, oh, I spent like 10 minutes. What did you really spend 10 or did you spend 12 or 13? Because those extra minutes can make a big difference on what you can bill. And what I have found is most providers under that.

Don’t document it well, and as a consequence upon audit, it’s going to be a problem. One of the things that I do is I work with ChiroSecure on dealing with offices that are audited. And when they’re audited, it’s often about coding and what they’ve paid. And what they’re looking for is did you document what they paid you.

They’re not looking at medical necessity, as much as everyone thinks. They’re really looking for. If you billed me for two units, did you do it? And so I will tell you to prevent and take away that entire risk. Make sure the time is simply documented by how much time did you spend. So here’s another example that you can see.

Hey, look, I’ve got both codes. I did 24 minutes of neuromuscular education, which on its own would be to. As well as 23 minutes of therapeutic exercise, which would be enough on its own. But when we told them notice it’s 47 minutes, does 47 minutes equal four units. It does not. It’s three. So even though you did enough for each, if they were individual, it would be the same.

What if I just did 47 minutes of exercise? So I hope you can see the point here. Make sure you look at the cumulative nature. And in this case you could be. Two units of neuromuscular education and one unit of Vectrus size. And the reason you build two units, neuromuscular education, partly it’s the higher value service, but because you’re spending more time doing that one.

So I want to make sure it’s clear that the eight minute rule does fit, but whether you’re doing a single service or multiple services, it’s going to be the total time spent on each. And for any single service to be billed, even in a multiple situation has to be at least eight minute. Now, what are the acceptable things for documentation?

And this is where I think, I hope I can give you some tools here. Don’t get overly fancy. It’s pretty straightforward. Specify the number of minutes. Simply say I did manual therapy to the lumbar spine trigger point work, whatever the case may be for 15 minutes. That will be adequate. Now I’m one to think.

Whenever you tell me exactly 15 minutes, I’m not saying I don’t believe you, but I want to know. Did you set a time? Because exactly 15 now with exercise, I don’t think that occurs because I don’t think you start and stop at zero and 15, but with massage or manual therapy, you might. So those, I think makes sense if they’re exactly 15, but others I think are going to be different.

So by example, listing time by number of minutes or listing time by from into, so you can say nine 30 to nine 40. Notice both of them are 15 minutes. I think if you document in the latter version, chances are, it’s going to be more accurate because let’s face it. Whenever you tell someone, Hey, how long does it take to drive somewhere else?

Oh, it takes like 30 minutes knowing full well it’s 30 minutes in a perfect scenario hill, not 30 minutes in the scenario that we’re dealing with, which means a little bit of traffic. So if you give the actual time, generally going to be much more than just simply that now keep in mind. I’ve given you two ways that are accessing.

That’s it let’s talk about what’s unacceptable. You can’t simply say I did a unit. A unit could be as little as eight and as much as 22, so insufficient, you cannot give a range. Don’t write down. I spent somewhere between six and 12 minutes. If you write that, just write the number of minutes. Never arrange.

What that tells me is you have no idea. You also don’t want to put things like I did exercises by. No, not enough. That means you have to do at least 23 minutes or the last one. And this is a common one. We have a sheet that we check off the services. We do. I get that. But when you check off, you’ve done NMR or tr you know, therapeutic exercise.

You better also document what were those exercises? How much time was spent on them, because then that way it’s going to be clear. So just be clear about giving me minutes or from in to time. This is not that complicated. In fact, we try to always be a resource for you, the HJ Ross company, if you’ve not been, go to our web.

HJ Ross Take a look at our new section. I’ve got updates and blogs here weekly on billing and coding for neck pain, the Medicare sequence duration what’s going on. And I’d love for all of you. Also take a moment, go to our Facebook page, HJ Ross Company, give us a like there so we can update you.

But also it’s a way for us to communicate to you because we’re always going to be a resource for you. We have a service that I can help you with the network. So if you want day to day, help check out that resource because it’s something that I become part of your team. What I’ll say to all of you. You are important to your family.

You’re important to your patients, but it’s more to be good than just simply important and continue to do that next week’s show it will be Sherry McAllister. I wanna thank everyone for your time. Hope to see you as soon to talk to you. HJ Ross Company, where your resource take care everyone.