23 Miss. Code. R. 200-1.13 - Rounding of Timed Codes
A. The Division of
Medicaid requires providers to adhere to Current Procedural Terminology (CPT)
and Healthcare Common Procedure Coding System (HCPCS) billing and coding
guidelines when reporting timed-based services.
1. Providers are required to bill for
services according to Medicaid National Correct Coding Initiative (NCCI) coding
policies, the Fee Schedules on the Division of Medicaid's website and
Administrative Code.
2. Should a
conflict arise between this rule and specific CPT/HCPCS coding guidelines, the
CPT/HCPCS guidelines take precedence.
B. Documentation must support the level of
service billed and the medical appropriateness of the service by providing a
detailed description of services provided.
C. Providers may bill for CPT/HCPCS codes
with 15-minute allotment as follows:
1.
Providers may bill the first initial unit if direct patient contact time is at
least eight (8) minutes.
2.
Providers may bill for additional 15-minute increment units after completing
the initial full fifteen (15) minutes of service, if at least eight (8) minutes
of the next time block are used to perform direct patient services.
3. Providers may not round up to the next
timed code if less than eight (8) minutes of direct patient services are
performed of a 15-minute increment.
D. Providers may bill for units of service
that are measured in minutes based on the following:
1. The provider must have provided services
for more than half of the time allotment in the code description for the
service to bill the unit of service.
2. Additional units may be billed in
increments, provided that at least more than half of the time of each billable
increment has been provided.
3.
Providers are not permitted to bill for a unit of service if half or less than
half the time requirement is met.
E. For time-based, evaluation and management
services, providers must document the activities related to the beneficiary
visit including the total time with start and end times of all procedures or
services performed for time-based codes. Total time includes all activities
related to the visit performed by the physician, physician assistant or nurse
practitioner on the date of the visit and may comprise activities including,
but not limited to the following:
1. Preparing
to see the beneficiary, including review of previous documentation and test
results,
2. Obtaining and/or
reviewing separately obtained history,
3. Ordering medications, tests, or
procedures,
4. Documentation of
clinical information in the health record or other records; and,
5. Communicating with the patient, family, or
caregiver.
F. Providers
may round CPT/HCPCS procedure codes with a one-hour allotment as follows:
1. Providers may bill one unit for one hour
of service if at least forty-five (45) minutes but less than 60 minutes is
spent with the beneficiary.
2.
Providers may not round up to the next level of service if total time spent
with the beneficiary is equal to or less than forty-five (45)
minutes.
3. If a more appropriate
time code is available according to Medicaid National Correct Coding Initiative
(NCCI) coding policies, the provider must bill the available code.
G. The Division does not allow the
billing of mixed remainder minutes across multiple codes.
H. The Division of Medicaid may conduct
audits of provider billing to ensure compliance with rounding rules and recoup
payments as necessary.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.