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Overview
Video Play Time: 21:22 min
- Introduction (0:00 – 0:15)
- Timed Codes (0:15 – 3:24)
- How to Pick the Right Code (3:24 – 5:27)
- Common Codes for OT (5:27 – 9:17)
- Orthotic Codes (9:17 – 10:44)
- Education Is Billable (10:44 – 11:29)
- The 8-Minute Rule (11:29 – 15:40)
- How Units Are Calculated (12:12 – 15:40)
- Substantial Portion Methodology/SPM (15:40 – 16:53)
- Coding Examples (worksheet coming soon) (16:53 – 20:50)
- Review and Conclusion (20:50 – 21:22)
Amplify OT Resources
- How to Bill for OT Under Medicare Part B
- OT Billing Guide
- How to Apply the 8-Minute Rule in OT Billing
- 8-Minute Rule: OT Billing Q&A Podcast
This Lesson’s Handout
Lesson Content
Responses
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I feel I’m a little bit confused about the 8-minute rule. My understanding is OT can bill multiple codes in one session, such as therapeutic exercise and self-care. However, when you consider reimbursement through medicare, you consider the whole therapy time rather than each therapy activity. So, could you explain more about how that works to bill multiple codes in that situation?
Certainly! You must consider the total treatment time and the activity you provided to accurately bill for an OT visit.
The activities or interventions tell you what codes to pick.
The total treatment time then tells you how many units of those codes you can bill.
So, if you have a 30-minute visit, you can bill up to 2 units. Based on your interventions, you could bill 2 units of the same code or 1 unit of 2 different codes.
If you have untimed codes as part of the picture, the amount of time you spent providing the service that falls under the untimed code would be deducted from your total treatment time to then help you decide how many timed codes you can bill.
So if you have an hour visit and 25 minutes were spent on the evaluation (an untimed code), the total remaining treatment time would be 35, so once again, you could bill up to 2 units of untimed codes and these could again be 2 unit of the same code or 1 of 2 different codes.
Even though you calculate units differently under Substantial Portion Methodology (SMP) you still have to consider the activity and the treatment time but the way you divvy up that time in units can be different.
Does that clear things up a bit?
I think it is worth mentioning that you should not use the 8 minute rule as a “normal” part of your planned scheduling process your patient will suffer in the long run. If a patient is being treating 3x a week, they lose a lot of therapy time by missing those 7 minutes every session!
Definitely! Especially times where you have a schedule, it’s a lot easier to use round numbers like 45 or 60 minutes vs using the 8-minute rule thresholds.