CPT Code and Billing Unit Checker

Visit check for Marshall Craig, treated by Martha Davila PT at Graywell Physical Therapy. Billing method given: 8-minute rule, total timed minutes.

Minutes check

• Ther ex 22 + manual therapy 16 + neuromuscular re-ed 9 = 47 timed minutes. This matches the 47 in the note.
• Hot pack (10 minutes) is untimed, so it is not added. 47 + 10 = 57 total treatment minutes, which matches the note.

Units supported by the minutes (using the rule you gave)

• 47 timed minutes under your stated method supports 3 timed units (45 minutes is 3 units, and the 2 remaining minutes do not reach the 8 needed for a fourth).
• Planned timed units: 2 + 1 + 1 = 4.

Code by code

• 97110 (ther ex): 22 minutes, planned 2 units. Status: Over. 22 minutes is one full 15-minute unit with 7 minutes left over, which is not enough for a second unit on its own.
• 97140 (manual therapy): 16 minutes, planned 1 unit. Status: Matches. 16 minutes is one full unit with 1 minute left over.
• 97112 (neuromuscular re-ed): 9 minutes, planned 1 unit. Status: Cannot check on its own. 9 minutes does not make a full unit by itself, so whether it earns a unit depends on how the leftover minutes (7 from ther ex, 1 from manual therapy, 9 here) are combined under your stated method.
• 97010 (hot pack): untimed, planned 1 unit. Status: Matches, billed once. The note documents 10 minutes of hot pack.

Overall: planned timed units (4) are one more than the minutes support (3). We recommend not submitting as written.

Documentation gaps

• Every billed code has a matching service in the note. No timed service is missing a code.

Modifier notes

• GP is planned on all four codes. No reason was given, see the questions below.

Fix list

1. Have Martha Davila PT or your certified coder decide where the 3 supported timed units belong. The minutes alone give 1 full unit to ther ex and 1 to manual therapy, with 7, 1, and 9 minutes left over on ther ex, manual therapy, and neuromuscular re-ed. The coder decides where the third unit goes.
2. Correct the planned timed units from 4 to 3 before Matthew Ellis submits. The planned 2 units on 97110 are not supported by 22 minutes alone.
3. Confirm the GP modifier requirement and the 8-minute rule details with the payer or a certified coder.
4. Confirm with the payer or a certified coder how 97010 should be billed for this visit.

Questions for the owner

• Which payer is this, and does it accept the 8-minute rule total minutes method as you described?
• Is GP required by this payer on every code, and is that the reason it was added?
• Should the therapist or coder decide which code gets the third unit, since the leftover minutes are 7, 1, and 9?

The final coding decision belongs to the treating therapist or your certified coder.