March 2024, third week. I’m reviewing claims data for a PT clinic in Woodbridge, New Jersey and something doesn’t smell right. On Tuesday afternoon, their therapist recorded 22 minutes of therapeutic exercise (97110) and 20 minutes of manual therapy (97140) for a patient. Total treatment time: 42 min. The biller billed 3 units for the 97110 and 2 units for the 97140. Five units in total.
Should have been four.
The biller was rounding each code separately, instead of totaling the minutes of treatment and then dividing out units. That one mistake, multiplied by 14 patients a day, five days a week, had quietly overbilled Medicare for almost two months. So when I ran the numbers the clinic was up-coding about $4,300 worth of claims that were technically fraudulent under CMS rules. Not on purpose. Not because of. Because nobody explained to the biller how the 8-minute rule actually worked.
And here’s what annoys me. The biller had been around. She had been coding PT claims for 6 years. 6 years of doing it wrong.
For more info click below link:
The 8-Minute Rule in Physical Therapy Billing Explained