How Billing Code Times are Calculated

Billing Codes: Untimed vs. Direct Timed vs. Pseudo-timed

Contents:

• Untimed Codes
• Direct Timed Codes
• Pseudo-timed Codes
• FAQ about Pseudo-timed Codes

Typically, the CPT codes used to bill for rehab therapy services fall into one of two categories: untimed or direct timed. In WebPT, these two categories of codes appear in the billing area of the documentation—that is, within the Billing tab of an evaluative note or the Objective tab of a Daily Note. However, there are a few outliers to this CPT code dichotomy: pseudo-timed codes. Before we get into the details of pseudo-timed codes, though, let’s review the differences between untimed and direct timed codes as well as how to bill for each.

Untimed Codes

Example of Untimed Codes located within the billing area of WebPT documentation

Within the Healthcare Common Procedure Coding System (HCPCS), certain services—and the codes designating those services—are not defined by a specific timeframe. These codes are known as “untimed,” meaning the provider can only charge for one unit, regardless of the amount of time he or she spent performing the service (in many cases, that means the provider can only bill one unit per date of service).

Example of Using an Untimed Code in WebPT

Here’s an example: a therapist performs a physical therapy evaluation for a new patient, a service indicated by the CPT code 97001. Regardless of the amount of time the therapist spent providing the evaluation, he or she would charge for one unit. For payers that follow the 8-minute rule—including Medicare—the therapist still must document the number of minutes he or she spent on each service (even those that are untimed). To make this easy, WebPT provides a special checkbox for untimed codes. That way, only one billing unit is charged out for that service.

In the example shown below, the provider spent 30 minutes performing the PT evaluation. Because the patient has Medicare—which uses the 8-minute rule—the therapist must indicate the number of minutes he or she spent providing the evaluation. The system will then add those minutes to the number of Total Treatment Minutes, which displays at the top of the billing section. But because the user checked the box, the system will automatically bill only one unit for the service.

Untimed Code example

Direct Timed Codes

Example of Direct Timed Codes located within the billing area of WebPT documentation

When a therapist performs a service indicated by a direct timed code, the number of units the therapist can bill for that service depends on the amount of time he or she actually spent delivering the modality. Please note that any time spent performing unskilled pre- and post-delivery services (i.e., preparation and cleanup) does not count toward the treatment service time. In other words, the time counted as part of the “intra-service care” total begins when the therapist or physician—or an assistant under the supervision of a physician or therapist—is directly working with the patient to deliver treatment services. At that point, the patient should already be in the treatment area (i.e., on the treatment table or mat, or in the gym) and prepared to begin treatment.

Many of the CPT codes used for therapy modalities, procedures, and tests and measurements specify that each unit of the code represents 15 minutes of direct (i.e., one-on-one) time spent in patient contact. To bill for the services provided on a single date of service (i.e., single calendar day), providers report procedure codes for services delivered along with the appropriate number of 15-minute service units.

Example of Using a Direct Timed Code in WebPT

Here’s another example: a therapist spends 15 minutes of direct time with the patient performing therapeutic exercise. As shown in the image below, the provider types “1” next to “Therapeutic Exercise” (CPT code 97110) and indicates the time spent providing this service, as the patient’s insurance is Medicare. The system will then add these minutes to the number of Total Direct Minutes, which displays at the top of the billing section.

Direct Timed Code Example.

If you’re billing a payer that follows the 8-minute rule, please see this article for specifics on units and minutes.

Pseudo-timed Codes

Pseudo-timed codes currently are not defined by CMS. However, CMS is proposing to distinguish a separate category of “direct timed codes” that fit the following definition: CPT codes that are defined by a specific timeframe other than the traditional 15-minute interval. For the purposes of this article, we will refer to those codes as “pseudo-timed.”

Here are some examples of pseudo-timed codes:

96125 - Standardized cognitive performance testing, per hour (OT)96105 - Assessment of aphasia, per hour (SLP)97545 - Work hardening/conditioning, first hour (OT)97546 - Work hardening/conditioning, each addl hour (OT)92607 - Evaluation for prescription alternative comm device, first hour (SLP)92608 - Evaluation for prescription alternative comm device, each addl 30 mins  (SLP)92626 - Evaluation Auditory Rehab Status, first hour (SLP)

Many of these codes appear within the Direct Timed section of the WebPT billing area. Thus, the system will add the minutes spent performing these services to the number of Total Treatment Minutes, which displays at the top of the billing section.

Examples of Using Pseudo-timed Codes in WebPT

EXAMPLE 1

An OT spends three hours on work hardening/conditioning. In the Direct Timed Codes section of the billing area in WebPT, the therapist will locate “Work hardening/conditioning; initial 2 hours,” charge for one unit, and indicate 120 minutes for this code. Then, to account for the remaining hour of treatment time, the provider will charge for one unit of “Work hardening/conditioning; each additional hour” and indicate 60 minutes for this code. The system will add all 180 minutes spent performing this service to the number of Total Treatment Minutes, which displays at the top of the billing section.

Pseudo-timed code example

EXAMPLE 2

An SLP spends two hours performing an evaluation for a prescription alternative communication device. The provider will charge for one unit of “Evaluation for speech-generating augmentative/alternative device; first hour” and indicate 60 minutes for this service. Then, to account for the second hour of treatment time, the provider will charge for two units of “Evaluation for speech-generating augmentative/alternative device; each additional 30 min” and indicate 60 minutes for this service. The system will add all 60 minutes spent performing this service to the number of Total Treatment Minutes, which displays at the top of the billing section.

Pseudo-timed code example