Time-Based Codes and the 8-Minute Rule
When coding on the basis of time in the outpatient setting, the total minutes of face-to-face time spent per encounter dictates how many units of a time-based code a qualified provider may bill.
Time spent reviewing records, waiting for the patient to enter your Zoom waiting room, troubleshooting technology issues with our patient care coordinators, and documenting the encounter without the patient present cannot be considered into the equation.
Even if pre and post encounter activities take more time than usual, it is not appropriate to report time spent beyond the face-to-face time with the patient.
Additionally, claims must be supported with appropriate documentation.
Foodsmart uses the '8-Minute Rule' as an algorithm for billing time-based current procedure terminology (CPT) codes valued in 15 minute increments, such as CPT codes 97802-4 for medical nutrition therapy services. In order to bill one unit of a CPT code valued in 15 minute increments, the service must be performed for at least 8 minutes.
"Rounding" is not permitted when calculating billable units, so minutes under the 8-minute threshold cannot be billed as an additional unit.
The 8-Minute Rule
The 8-Minute Rule uses the following ranges of minutes to determine how many units of a time-based code may be billed:
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
5 units: ≥ 68 minutes through 82 minutes
6 units: ≥ 83 minutes through 97 minutes
7 units: ≥ 98 minutes through 112 minutes
8 units: ≥ 113 minutes through 127 minutes
While the Medicare 8-Minute Rule is probably the most-referenced method for calculating billable units, not all payers follow this rule. Many private payers either have no stated policy or follow Medicare's policy. Best practice is to follow our guidelines or to contact the Clinical Operations team prior to providing services and billing.
Adapted from: https://www.eatrightpro.org/payment/medicare/providing-service-and-billing/time-based-codes-and-the-8-minute-rule
Visit Start/End Time = Zoom Phone Logs = Billing Units
Units billed should always reflect the time spent providing MNT with the patient present.
The start time and end time documented in the chart SHOULD ALWAYS equal Zoom meeting/phone time spent with the patient.
Billing units SHOULD ALWAYS reflect Start and End time documented in chart AND Zoom meeting/phone logs.
Chart notes with sparse or limited information and that are billed for 2-4 units will be sent back to the RD for adjustments.
Chart notes NEED to be completed and billed within 12 hours of appointment time.