billing and coding..

[justordinary]

1) Can you use 99213/99214 E&M code and use add-on 90833 psychotherapy code for a 20 minute f/u visit?
2) Can you use 99204/99205 E&M code for a 60 min new eval and also use 90838 psychotherapy code since you are seeing the patient >53 face-to-face? (or use 90836 if the visit ends somewhere around 38-52 min...?)

Thanks for all the experts on the coding and billing subject..!

---

Members don't see this ad.

 

[WisNeuro]

From your APA.

"The time listed for the psychotherapy add-on code accounts ONLY for the time spent providing psychotherapy. Any time spent providing E/M services should not be included in the psychotherapy add-on time."

 

[rjs2131]

1) Technically yes but I wouldn't be comfortable doing a 99214 + 90833 for a 20 min visit. 99213 + 90833 maybe.
2) If 99204 or 99205 are based on MDM, you can then use a psychotherapy add-on code. If 99204 or 99205 are being used for time, I would use 99417 for every additional 15-min spent.

 

[romanticscience]

Question regarding clinical data you obtain in any intake form before meeting with the patient. This can count toward MDM criteria and reduce the effective face-to-face time?

 

[TexasPhysician]

I’m not aware of anything that says you can’t do 99214 + 90833 in 20 minutes.

Theoretically
1. Are you sleeping well on Trazodone?
Yes
2. Does the Zoloft continue to minimize anxiety?
Yes

18 minutes of therapy on minimizing the impact of panic attacks.

1.5 minutes of documenting

That address 2 chronic conditions and 16+ minutes of therapy. All patients won’t be this simple though.

 

[nexus73]

I’m not aware of anything that says you can’t do 99214 + 90833 in 20 minutes.

Theoretically
1. Are you sleeping well on Trazodone?
Yes
2. Does the Zoloft continue to minimize anxiety?
Yes

18 minutes of therapy on minimizing the impact of panic attacks.

1.5 minutes of documenting

That address 2 chronic conditions and 16+ minutes of therapy. All patients won’t be this simple though.

And you’d be better off spending 2 minutes each on 30 patients and generate 57 RVUs in 1 hour.

 

[clausewitz2]

I’m not aware of anything that says you can’t do 99214 + 90833 in 20 minutes.

Theoretically
1. Are you sleeping well on Trazodone?
Yes
2. Does the Zoloft continue to minimize anxiety?
Yes

18 minutes of therapy on minimizing the impact of panic attacks.

1.5 minutes of documenting

That address 2 chronic conditions and 16+ minutes of therapy. All patients won’t be this simple though.

Can't count documenting time for complexity if you have a psychotherapy add-on.

 

[TexasPhysician]

Can't count documenting time for complexity if you have a psychotherapy add-on.

I complete documentation and send scripts while the patient is present. Those 1.5 minutes could theoretically be spent on talking about anything then correct?

 

[calvnandhobbs68]

Question regarding clinical data you obtain in any intake form before meeting with the patient. This can count toward MDM criteria and reduce the effective face-to-face time?

I don't see why not. There's no restriction on utilizing information outside the encounter (or even from a different date) for medical decision making the day of service.

 

[FlowRate]

This is a more recent billing thread with a nicely generic name. Different question:

Example (pretty common) situation:

Follow-up for a patient with just one diagnosis. Had been trying different med doses by email since last appointment and had side-effects from a couple of them but found a dosing that's working well and now no side effects. First full appointment checking in since making those adjustments by email. No further changes recommended, symptoms now under good control. Does that meet criteria for "1 or more chronic illness with exacerbation, progression, or side-effects of treatment" or is it now "1 stable chronic illness"?

Our billing person says should code lv3 for that encounter but I think she tends to be somewhat conservative on billing so wanted some second opinions.

 

[calvnandhobbs68]

This is a more recent billing thread with a nicely generic name. Different question:

Example (pretty common) situation:

Follow-up for a patient with just one diagnosis. Had been trying different med doses by email since last appointment and had side-effects from a couple of them but found a dosing that's working well and now no side effects. First full appointment checking in since making those adjustments by email. No further changes recommended, symptoms now under good control. Does that meet criteria for "1 or more chronic illness with exacerbation, progression, or side-effects of treatment" or is it now "1 stable chronic illness"?

Our billing person says should code lv3 for that encounter but I think she tends to be somewhat conservative on billing so wanted some second opinions.

Part of the reason I don't do many med adjustments between appointments cause now you've done all that work for free...I'm kidding but only partially

Technically this is now 1 stable chronic illness on the date of the appointment (which is what matters) so unless you meet 214 criteria based on other items, it'd be a 213. You might be able to argue that it isn't REALLY stable since you had to do all that work between the last appointment and this one but I bet it'd go either way in an audit and they'd tend towards downcoding it.

 

[TexasPhysician]

Part of the reason I don't do many med adjustments between appointments cause now you've done all that work for free...I'm kidding but only partially

Technically this is now 1 stable chronic illness on the date of the appointment (which is what matters) so unless you meet 214 criteria based on other items, it'd be a 213. You might be able to argue that it isn't REALLY stable since you had to do all that work between the last appointment and this one but I bet it'd go either way in an audit and they'd tend towards downcoding it.

Exactly. No kidding needed. Insurance practices should do med changes at appointments.

 

[FlowRate]

I think it would be somewhat hard for me to switch from this mode of caring for patients to a more strict "only really connecting by appointment" model. For that reason, I'd probably have to go cash pay/more concierge focused if I ever left this job. My pay doesn't depend on the billing but I try to reasonably maximize what I do bill since it does matter some to the organizations as a whole.

 

[Merovinge]

I think it would be somewhat hard for me to switch from this mode of caring for patients to a more strict "only really connecting by appointment" model. For that reason, I'd probably have to go cash pay/more concierge focused if I ever left this job. My pay doesn't depend on the billing but I try to reasonably maximize what I do bill since it does matter some to the organizations as a whole.

People expect this more since telephone/zoom appointments became the norm with COVID. I know my pediatrician office now charges $25 (not run through insurance) for a telephone visit if you are calling after hours. People call with life-threatening situations for a wee one and they can do this (I always hear psychiatrists saying they can't charge or this violates laws about being accessible to patients on this board). I think its time doctors in general get paid for their time instead of the norm being to offer care for free.

 

[FlowRate]

People expect this more since telephone/zoom appointments became the norm with COVID. I know my pediatrician office now charges $25 (not run through insurance) for a telephone visit if you are calling after hours. People call with life-threatening situations for a wee one and they can do this (I always hear psychiatrists saying they can't charge or this violates laws about being accessible to patients on this board). I think its time doctors in general get paid for their time instead of the norm being to offer care for free.

I have heard of some organizations looking into being able to charge for email potentially. I can certainly bill as a phone appointment if I choose to call someone. As it stands, we get 2 hours of admin time per day which is explicitly for email, phone, and papework stuff. The theory being that we have fewer appointments for straightforward issues and are able to care for a larger panel of patients (which is more income for the organization and indirectly for us.)

For cash PP folks, I guess it's a decision as to whether ancillary services are essentially bundled in your cash fee/limited face to face hours or if you charge separately.