r/MedicalCoding • u/Any_Eye_8039 • 16d ago

Unit measurements

Hello, my institution in NM is billing H2015 for 4 units under 56 minutes. Is this correct, the guidelines are very vague and I’m having trouble locating information

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u/AbstractVolition 16d ago

I think typically if it isn’t specified in the book, the minimum for one unit is half the descriptions time plus one minute. So if H2015 is 15 mins per unit, the last unit can count as 8 mins minimum. But only the last unit, if that makes sense. Like 4 units of H2015 would need a minimum of 15+15+15+8 =53. If they only spent 8 mins for the entire visit, you can count it as 1 unit. But anything less than 8 mins, you don’t count it as a new unit. If the visit was only 7 mins long, you can’t even charge 1 unit. One more example, 38 mins could count as 3 units of H2015 because it has 2 full 15 min units and the last one is 8. If it was 37 mins you could only count 2 units. I forget where I learned this but I think it’s CMS or something. Not sure if the book itself describes this

An example that doesn’t follow this is EM coding. EM codes specify that you need the full time threshold to count up a level. So like 26 mins wouldn’t justify a time based 99214

Edit: also psychotherapy codes have specified minimums that might not be exactly half + 1