Coding/Billing Flashcards
CPT-4
- Current Procedural Terminology, versio 4
- published by AMA
Most codes used by PTs/PTAs are in the ____ range
- 97xxx
- no such thing as PT codes except for PT eval and PT re-eval
Types of CPT Codes
- time codes
- untimed codes
Timed Codes
- usually 15 min (can be billed in multiples)
- must supervise pt to be billable
Time:
-face to face tie with patient
if you’re not supervising the care, then you can’t bill for it
unit of time is attained when:
- when mid-point is passed
- for example: our obtained when 31 min have elapsed, 2nd hour when 91 min have elapsed
Billing for untimed codes
-always bill, no matter what
eval, hot pack, e-stim
1 unit=
2 units=
3 units=
4 units=
1=8+ min
2=23+ min
3=38+ min
4=53+ min
NCCI
-National Correct Coding Initiative
NCCI Edit Pairs
- created by private company on contract to CMS
- Identify codes that can’t be billed on same day (n) or can’t be billed simultaneously (m)– ‘m’ must be done sequentially
untimed codes _____ apply to the 8-23 minute rule
- do NOT
- just bill no matte what
all timed codes added up ______ to the ____ min rule
- DO APPLY
- 8-23 min rule
timed codes do not ______ in the 8-23 min
stand on their own
in the CPT rule each code _____ & has to be at least ____ min each
- stands alone
- 8 min each
What to bill for?
CPT
-timed codes are for face-to-face time
