CPT codes are part of the day-to-day life in Physical Therapy. Can?t do much without them. While there are several hundred Physical Therapy CPT codes that can be billed out, the more frequently used codes are much fewer. When it comes to billing, the Medicare 8 minute rule looms large.
8 Minute Rule in Therapy?An Outsized Role
You have both timed and untimed CPT codes. In terms of an individual clinic?s revenue, timed codes likely constitute the majority of revenue and are therefore disproportionately important to a Physical Therapy practice. Billing for timed codes is set by the 8 Minute Rule. For what looks like a fairly simple rule, the 8 Minute Rule plays an outsized role in the operations of a PT clinic. No wonder there is so much interest in the topic in the PT space. Per SEMRush, there are 22,000 searches for the 8 minute rule every month in the US on the web.
Understanding the 8 Minute Rule, how it works, how to avoid errors, and how to ensure money is not left on the table is clearly crucial. There is a lot of content available on how the rule works so we will not get into specifics and will avoid rehashing the content. But a quick preview may be helpful.
- Physical therapy units are counted in blocks of 15 minutes.
- 8 minutes or higher is counted as one unit.
For the Medicare version of the rule:
- All timed units are added together and the total time is divided by 15.
- If the remainder is 8 minutes or greater, then an extra unit is added.
- This gives us the total number of billable units.
- Partial time blocks (under 8 minutes) are added together and the resulting additional units are assigned to the ?winner,? the CPT code with the most remainder minutes.
- However, if there is no winner identified then the partial units could be assigned to the code with the highest reimbursement rate.
For the AMA 8 Minute Rule:
- All time blocks are considered separately to determine the number of units, each service more than 8 minutes counts as one unit. But remainders cannot be combined to bill additional units like in the Medicare version.
8 Minute Rule?Billing Physical Therapy Units
You would lean on your EMR to ensure the 8-Minute Rule is correctly set. As a result of clinical documentation that is created, the system would automatically create charges for the CPT codes, knowing which are time-based codes and which are not.
In the EMR software, a fully featured flowsheet would track exercises and other time based codes via a robust process that is both efficient and compliant. A good way to justify Physical Therapy coding would be to enter supporting documentation in the flowsheet.
The flowsheet is more than an exercise log. It would be a full list of all services rendered and include the duration of services (used to calculate the number of units), scope of services rendered (repetitions, sets, and durations), and supporting documentation to justify services delivered. As the foundation of Physical Therapy billing, the flowsheet documents what the clinician is doing and billing out and why it is being done. In the absence of supporting documentation in the flowsheet, payments for services could potentially be withheld or recovered by payers.
Typically, when we refer to the flowsheet, we are talking about three things: the flowsheet itself, the daily SOAP note, and charges. Building everything for the daily encounter into one EMR screen should be helpful. The daily note would automatically check off what was done in the previous encounter and enable copying forward of the previous note. Charges would be ingrained into the documentation process based on the appropriate 8 Minute Rule and Payer Fee Schedule.
You would start off with common templates that can be customized, searching in the exercise bank to find these templates. Exercises could also be created on the fly. The flowsheet would carry forward settings from the previous encounter. Therapists would review services done the previous time: Sets, reps, weights, tension, and custom notes. Accessing the individual history of each service would show the progress over time. The most important part of the flowsheet for efficiency and billing compliance would be documentation of time spent doing the exercise. When the flowsheet is saved, the system would automatically generate charges. Based on the specific timed codes, the appropriate payer rules would be applied along with modifiers by the billing rules engine.
It should also be possible to add charges manually by adding a line item into the flowsheet and attaching it to a specific code, basing it on the list of all fees that is available. Also, the system would differentiate between codes that are allowed by the patient?s payer class and those that are not. It would document the latter codes but avoid billing them so as to avoid denials or rejections for codes that are not supported by the payer class.
End of the day, the 8 Minute Rule governs how much money the practice makes from timed Physical Therapy codes. Making sure it is correctly implemented would be crucial to any PT practice. After all, progress is measured in 8 minute blocks.
