For those of us in the physical therapy field, understanding the nuances of coding can feel a bit like solving a Rubik’s cube. The complex world of coding is made even more complicated by different rules for different insurance types, all with their own jargon. Today, let's unravel two crucial AMA billing rules: the Total Minute Rule and the AMA Rule.
Often dubbed the Medicare "8-min Rule," the Total Minute Rule is one of the key methodologies employed by Medicare and other federal payers. Conversely, commercial insurance providers usually lean towards the AMA Rule, also known as the Substantial Portion Methodology (SPM) or Rule of 8s.
However, in the throes of a bustling clinic, we sometimes find it difficult to distinguish between these two methodologies and make sure all therapists within our organization understand the rules and are using them correctly. This is where PredictionHealth steps in, offering a clear, user-friendly way to determine if your therapists understand and apply the appropriate coding rules. The Coding Efficiency feature within the PredictionHealth platform allows practice groups to easily track how therapists are coding and helps to identify where there may be opportunities to more efficiently code visits to ensure no units are being left uncaptured.
The Total Minute Rule calls for billing based on the overall time spent with the patient, regardless of the various CPT codes that could be involved. We simply total the minutes to calculate the number of units we can bill. Here's a quick breakdown:
- 8-22 min = 1 unit
- 23-37 min = 2 units
- 38-52 min = 3 units
- 53-67 min = 4 units
- 68-72 min = 5 units
The AMA Rule, on the other hand, hinges on the time spent on each unique CPT code rather than the total time with the patient. For each unique CPT code, 8-22 minutes equates to one unit, 23-37 minutes equates to two units, etc…. This incentivizes therapists to bill multiple unique codes, each clocking at least 8 minutes.
To clarify the difference between these two rules, let's delve into a few scenarios:
Scenario 1
Total Minute Rule |
AMA Rule |
10 min Therapeutic Activity |
10 min Therapeutic Activity |
8 min Manual Therapy |
8 min Manual Therapy |
Total: 18 min, 1 Unit |
Total: 18 min, 2 Units |
Scenario 2
Total Minute Rule |
AMA Rule |
6 min Therapeutic Activity |
6 min Therapeutic Activity |
6 min Therapeutic Exercise |
6 min Therapeutic Exercise |
6 min Manual Therapy |
6 min Manual Therapy |
Total: 18 min 1 Unit |
Total: 18 min 0 Units |
Scenario 3
Total Minute Rule |
AMA Rule |
10 min Therapeutic Exercise |
10 min Therapeutic Exercise |
10 min Manual Therapy |
10 min Manual Therapy |
10 min Neuro Re Education |
10 min Neuro Re Education |
Total: 30 min 2 units |
Total: 30 min 3 units |
Scenario 4
Total Minute Rule |
AMA Rule |
30 min Therapeutic Activity |
30 min Therapeutic Activity |
4 min Therapeutic Exercise |
4 min Therapeutic Exercise |
7 min Manual Therapy |
7 min Manual Therapy |
Total: 41 min 3 units |
Total: 41 min 2 units |
Scenario 5
Total Minute Rule |
AMA Rule |
25 min Therapeutic Activity |
25 min Therapeutic Activity |
10 min Manual Therapy |
10 min Manual Therapy |
Total: 35 min 2 units |
Total: 35 min 3 units |
Scenario 6
Total Minute Rule |
AMA Rule |
8 min Therapeutic Activity |
8 min Therapeutic Activity |
8 min Therapeutic Exercise |
8 min Therapeutic Exercise |
8 min Manual Therapy |
8 min Manual Therapy |
8 min Neuro Re Education |
8 min Neuro Re Education |
Total: 32 min 2 units |
Total: 32 min 4 units |
Navigating the intricate landscape of CPT codes and billing can be daunting, but understanding the rules and knowing how to apply them can significantly streamline the process. Remember, the key lies in optimizing your time spent on each CPT code and documenting it accurately. PredictionHealth’s Coding Efficiency feature will help you ensure that your therapists are managing their time and coding during their visits optimally. To learn more, click here or Book a Demo.