Session Start and Stop Times: Why “45 Minutes” Is Not Enough on a Progress Note

A supervisee asked me this one recently.

“Why do we have to document the start and stop time? Can’t I just write the total time, like 45 minutes?”

Fair question. It is one more thing to track at the end of a long day, and if you are already writing the duration, writing the clock times can feel redundant.

Here is why it matters.

Start and Stop Times Are How Insurers Verify the Session

When a payer reviews a claim, they are not only looking at the CPT code. They are looking for a record that supports it. Start and stop times are part of that record.

The common psychotherapy time codes sit inside specific ranges:

• 90832: 16 to 37 minutes
• 90834: 38 to 52 minutes
• 90837: 53 minutes and above

If your note says “45 minutes,” an auditor cannot see how you arrived at that number. They cannot see what time the session started, what time it ended, or whether the minutes included anything that should not be billed. A time range shows the structure of the session and supports the code you selected.

In a review, those clock times help answer a simple question. Did this session occur the way the note describes it?

Why This Is Worth Building Into Your Routine Now

Start and stop times are one of the most common triggers for clawbacks. That is not me being dramatic. That shows up in audit reports over and over, and it shows up across payers. The fix is almost always a simple routine change..

If you write clock times while you are still in the room, it takes seconds. If you try to reconstruct them at the end of the week, the risk of a mismatch goes up fast.

A few practical ways I see clinicians build this in:

• Note the start time in the first line of the note as soon as the session begins.
• Note the stop time before you leave the room or close the telehealth window.
• If your EHR autofills a duration, still write the clock times. The duration alone is not the record.
• Use a template so the field is always there. If it is blank, you notice.

These are small habits. They protect the work you are already doing.

Where This Fits in the Bigger Picture

Start and stop times are one of the most common clawback triggers, but they are one piece of a larger puzzle. Intake, diagnostic assessment, treatment plan, progress notes, case consults, and discharge summary all need to line up. When they do, your record tells one clean story. When they do not, small gaps turn into big questions.

That is what the Write it Right: Clinical Documentation Series covers. Four self-paced courses that walk you through the full golden thread, from intake to discharge, in a way that is clinically useful and immediately applicable:

1. SOAP Notes (live and available now)
2. Diagnostic Assessment (almost finished)
3. Treatment Planning (almost finished)
4. Case Consults, Summaries, and Discharges (coming soon)

You can start with a single course or move through the full series. Either way, you leave with documentation that reflects the work you are already doing and holds up if someone looks closely.

Explore the full series at goldenthread.therapistresources.com.

Resources

SOAP Notes Session Checklist

Free session checklist

SOAP Notes Training Course

Learn to write audit-ready SOAP notes