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Primary Care Coding Alert

Reader Question:
Look to the Clock to Calculate Counseling Units

Question: We recently saw a patient for a nutrition therapy counseling session. The session began at 3:00 PM and ended at 3:52. Can we bill for a full hour, or 97802 x 4, for this encounter?

SuperCoder Subscriber

Answer: As its descriptor states, 97802 (Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes) is a time-based code. Per the descriptor, you would bill in increments of 15 minutes.

As the session you describe lasted for 52 minutes, you will not be able to bill for a full hour, or for the four units that you suggest in your question. This is because of established CPT® guidelines, which state, "A unit of time is attained when the midpoint is passed." That means, for a timed CPT® code measured in 15-minute units, like 90782, providers bill a single 15-minute unit for treatment greater than or equal to 8 minutes through and including 22 minutes. Because 52 minutes is only 7 minutes longer than 45 minutes, a fourth unit of 97802 has not been achieved.

Using this formula, Medicare and payers that follow CPT® guidelines would regard four 15-minute units as a period between 53 minutes through 67 minutes. Three 15-minute units, however, are regarded as a period between 38 minutes through 52 minutes (See the Medicare Claims Processing Manual, 20.2.C, found at https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c05.pdf).

So, as this session did not meet the threshold of 53 minutes, you would bill 97802 x 3.