billed. What was the type of service? What area was it applied? If it's a time service, was time documented. Don’t forget the purpose. If you're applying an electric stim remember the purpose generally is going to be for pain, swelling or spasm, so you would want to indicate where is it being applied and why, and then how much time. Now, of course, unattended doesn't have a time value but services such as massage or exercise having a time value very important to always indicate time. Here's an example of a review that came in for a doctor and shows here what they're saying, these were the deficiencies noted. Highlighted in yellow, the first bullet notes, “Lack of documented patient evaluation.” On this one they're just saying they didn't see an evaluation at all. They're also showing that there's no documentation of an individualized plan of care. There's a lack of documentation to patient's progress or response to treatment. Then this was a patient, if you look at the fourth bullet that had exercise. Exercise is very common for chiropractors to perform particularly for neuromusculoskeletal conditions and here it's noting in the fourth bullet “Lack of documentation of the specific exercises performed.” You can't just say I did exercise but just indicate what exercises did we do? Did we do sit-ups, back extensions, McKenzie's protocol, how many sets, how many repetitions, and then of course how much time. Notice the very last bullet, “No documentation of time spent with the patient.” When you have a time service it does require that you’d be face to face with the patient. Remember for time this is what insurances are going to look at. They use the Medicare eight-minute rule for physical medicine services. To bill one unit of a physical medicine service that has a 15- minute time value you must spend at least eight minutes, so that's the minimum time. If you only spend seven minutes, technically not billable. Make sure that there's documentation if you're doing one unit of at least eight but up to 22 minutes. For two units, it must be 23 minutes as a minimum up to 37. If you do only 20 minutes of two services, 10 minutes of one and 10 minutes of the other that would not qualify for two units and definitely something on a review. If you’ve billed for two units and only 20 minutes is documented there's going to be a problem on that review. Make sure that you always go with the eight-minute rule. Notice three units requires 38 and so on it goes. Make sure always time, time and time is documented because they’re always going to review for that as well.
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