IMPORTANT NOTES ABOUT THE 15 MINUTE RULE:
- The 15 minute rule requires you to utilize the Flowsheet section of your documentation to enter your charges.
- It won’t be able to override the Medicare 8 minute rule for Medicare patients. For compliance, the Medicare 8 Minute rule cannot be disabled for Medicare patients.
- If you have enabled user setting for Medicare 8 minute rule to apply to all insurances, the 15 minute rule can override that user setting for non-Medicare patients once enabled.
How to enable the 15 Minute Rule for Non-Medicare Patients
1. Go to the patient dashboard > Edit Patient
2. Under Edit Patient, go to the Insurance tab
3. Select “Yes” for “Enable 15 minute rule”
4. Select Save Changes
How to Enable Auto 15 Minute Rule to All Users
By default, this is set to NO. When set to YES, the 15 minute rule will be applied automatically for a patient, if the primary payer is non-Medicare. This will apply to all users, even if the auto 15 minute rule is enabled for a single user.
15-Minute Rule for Timed Codes
The following are automatically calculated in In Touch EMR.
Units Number of Minutes
0 Units < 8 Minutes
1 Unit >= 8 Minutes and <= 22 minutes
2 Units >= 23 Minutes and <= 37 minutes
3 Units >= 38 Minutes and <= 52 minutes
4 Units >= 53 Minutes and <= 67 minutes
5 Units >= 68 Minutes and <= 82 minutes
6 Units >= 83 Minutes and <= 97 minutes
7 Units >= 98 Minutes and <= 112 minutes
8 Units >= 113 Minutes and <= 127 minutes
Note: There is no cumulative aspect to computing the correct charge if you have multiple CPT codes. This is the primary difference with Medicare 8 minute rule. In the 15 minute rule, the unit is computed per timed code based on their respective durations.
Sample computation under 15 minute rule: 97110 and 97035 are both timed codes
Under claim review, below is the result when 15 minute rule is enabled:
97110: 2 Units >= 23 Minutes and <= 37 minutes
97035: 0 Unit < 8 Minutes
Let’s look at an example to compare how the Medicare 8 minute rule and 15 minute rule would apply:
A patient was seen in your clinic for their initial appointment and you performed a Physical Therapy evaluation 97001 for 30 minutes, 33 min of therapeutic exercise 97110, 5 min of ultrasound 97035, and 15 min of Electrical Stimulation Unattended 97014/G0283.
Under the Medicare 8 minute rule: there are 38 minutes of time based charges and 2 visit charges. Because there are 38 minutes of time based charge you are allowed to bill 3 units for these procedures. With 33 minutes of Therapeutic Exercise, you are required to bill 2 units of 97110 because there are 2 full 15 minute units (30 minutes with 3 minutes left over). Ok, that’s 2 units out of 3, where is the additional unit coming from because you have 3 minutes of Therapeutic Exercise and 5 minutes of Ultrasound. Medicare allows you to compare the remaining minutes of time based procedures and bill the larger of the two procedures. So 5 is greater than 3 which makes Ultrasound the remaining time based charge. The correct charge under the Medicare Billing Guidelines is 1 unit of Physical Therapy evaluation 97001, 2 units of therapeutic exercise 97110, 1 unit of ultrasound 97035, and 1 unit of electrical stimulation unattended G0283 (Yes, Medicare has a different cpt code for Electrical Stimulation Unattended).
Under the 15 minute rule, there is no cumulative aspect to computing the correct charge. 33 minutes of therapeutic exercise is still 2 units. The 3 min left over of therapeutic exercise does not meet the requirement of exceeding the halfway point of the procedure so you cannot bill a third unit of 97110. The 5 minutes of ultrasound also does not meet the requirement of exceeding the halfway point of that procedure so you cannot bill for ultrasound. So the correct charge under this rule is 1 unit of Physical Therapy Evaluation, 2 units of Therapeutic Exercise, and 1 unit of Electrical Stimulation unattended 97014.
*97014 and 97001 are not timed codes and are not covered by either of these rules
ADJUSTING UNITS MANUALLY:
If you need to adjust units manually, you can do so by changing the units under the Claim Review tab.
Note: When you adjust the units manually, ensure that this is final and ready for submission. Proceed with save billing and finalizing the document. If you adjust the unit manually and saved the billing without finalizing the note, the next time you resume the note – the 8 minute rule will override the units and you would need to change the units manually once more according to your preference.