86 Billing One-on-One, Direct Patient Contact
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Dynamic Chiropractic – July 1, 2016, Vol. 34, Issue 13

Billing One-on-One, Direct Patient Contact

By Samuel A. Collins

QUESTION: I am trying to understand what "direct one-on-one patient contact" means in relation to physical medicine services; specifically, the timed services 97032 through 97036, constant attendance services; and 97110 through 97535, therapeutic procedures. Do I have to physically be in contact with the patient to qualify to report and bill these services?

This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services. For modalities such as ultrasound, CPT code 97035, clearly there will be direct one-on-one contact, as the ultrasound head must be hand-held during provision of the service, thus making contact clearly direct. However, services such as therapeutic exercise 97110 may not need direct "touching" contact, but visual and verbal contact only as the patient performs the specific exercises.

What Is Contact?

For modalities, "Constant attendance involves visual, verbal, and/or manual contact with the patient during provision of the service."1 For procedures, "From a CPT coding perspective ... Therapeutic procedure, one or more areas, each 15 minutes ... requires the therapist to maintain direct patient contact (i.e., visual, verbal and/or manual contact) during provision of the service."2

Contact must be sufficiently skilled to assure the procedure will cause the intended, specific therapeutic change. In other words, having an unskilled therapist simply watch a patient do an exercise incorrectly is insufficient.

Based on these definitions, you may indeed consider it contact without direct manual interaction; however, documentation should reflect not only the level of contact, but also the time of this contact, as all of these codes have a 15-minute time element that must be met for billing purposes.

Counting Time as a Function of Work

Pre-service time includes assessment and management time: medical record review, physician contact while the patient is present, assessment of the patient's progress since the previous visit, and time required to establish clinical judgment for the treatment session. Pre-service time is not the time required to get the patient ready to receive the treatment.

Intra-service time includes the hands-on treatment time.

Post-service time includes the assessment of treatment effectiveness, communication with the patient / caregiver to include education/instruction/counseling/advising, professional communications, clinical judgment required for treatment planning for the next treatment session, and documentation while the patient is present.

Counting Minutes for Timed Codes in 15-Minute Units

When only one service is provided in a day, providers should not bill for services performed for less than 8 minutes. For any single timed CPT code in the same day measured in 15-minute units, you can bill a single 15-minute unit for treatment greater than or equal to 8 minutes through and including 22 minutes.

If the duration of a single modality or procedure in a day is greater than or equal to 23 minutes through and including 37 minutes, two units should be billed. Time intervals for 1-4 units are as follows, as discussed in further detail in my previous article:

  • 1 unit: ≥ 8 minutes through 22 minutes
  • 2 units: ≥ 23 minutes through 37 minutes
  • 3 units: ≥ 38 minutes through 52 minutes
  • 4 units: ≥ 53 minutes through 67 minutes

The pattern remains the same for treatment times in excess of 1 hour.

References

  1. American Medical Association: CPT Assistant, July 2004, pg. 13.
  2. AMA: CPT Assistant, December 1999, pg. 11.

Editor's Note: Feel free to submit billing questions to Mr. Collins at . Your question may be the subject of a future column.

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