# ARNP billing



## medschool (Jun 23, 2018)

Should a ARNP who prescribes medication use 99213 & 90833? She sees these patient for 30 minutes. Can the ARNP use 99215 on a first visit?


----------



## thomas7331 (Jun 23, 2018)

medschool said:


> Should a ARNP who prescribes medication use 99213 & 90833? She sees these patient for 30 minutes. Can the ARNP use 99215 on a first visit?



Code choices have to be made based on the documentation of services and the rules of coding - there's really not way to answer your question with such a limited amount of information.  You can't assign a code correctly just based on the duration of a visit and/or the fact that a medication is prescribed.  If you could provide a sample note or give a little more information about exactly what the visit consists of, we may be able to help you more.


----------



## twizzle (Jun 23, 2018)

medschool said:


> Should a ARNP who prescribes medication use 99213 & 90833? She sees these patient for 30 minutes. Can the ARNP use 99215 on a first visit?


Why you would want to bill psychotherapy (90833) for prescribing medication, I have no clue....... prescribing a drug is not psychotherapy.
Secondly, if you want to bill these add-on psychotherapy codes, the time spent performing psychotherapy alone needs to be documented in minutes, and the E/M and psychotherapy documentation needs to be significant and separately identifiable. If they document 30 minutes with the patient and* ">50% was spent counseling", with a synopsis documenting what they counseled, you could code the visit on time which would support 99214, but you could not bill a psychotherapy code. Psychotherapy codes are not supported by the >50%  counseling statement.
If they just say "I spent 30 minutes with the patient" the statement has no meaning and you have to code on the 3 key components.
An ARNP can bill any level they want as long as the documentation supports the level, whether a first visit or subsequent visit.

I have just spent considerable time this week performing a provider audit where he billed E/M with add-on psychotherapy codes so trust me, I did a fair bit of research on this topic. 

Hope this is helpful.

Andrew Matheson LDS.RCS(Eng), CPC, CPMA, CANPC.*


----------



## medschool (Jun 23, 2018)

*Arnp*

The ARNP sees the patient for 30 minute of therapy and prescribes medication is necessary. All of the notes are therapy notes so I didn't know why she would use E&M codes.


----------



## mitchellde (Jun 24, 2018)

medschool said:


> The ARNP sees the patient for 30 minute of therapy and prescribes medication is necessary. All of the notes are therapy notes so I didn't know why she would use E&M codes.



the E&M code is needed for the prescription of the medication.  If the documentation supports the three key components for the 99213 to evaluate the medications and possible prescribe new drugs or renew presciptions then you may bill the 99213, if the provider then has a counseling session that is separately identified and timed as 30 minutes then you would use the add on 90833 for the counseling portion.


----------



## medschool (Jul 3, 2018)

*Clarification of question*

A ARNP sees a patient for a total of 30 minutes. Should there be documentation of history? Exam? Decision making? This should be for at least 30 minutes? Then if therapy is needed 90833? If the ARNP asks questions about how the meds are working and then takes 30 minutes for counseling how should this be coded. I'm unsure if the ARNP is completing the proper documentation to bill a E & M code. Or if she should just bill for therapy. Is it required to use a E & M code because she writes scripts and ask how they are working. I guess I just don't see this happening every week or once a month. Sorry for the confusion I am struggling with coding this correctly.


----------



## Pathos (Jul 3, 2018)

medschool said:


> A ARNP sees a patient for a total of 30 minutes. Should there be documentation of history? Exam? Decision making? This should be for at least 30 minutes? Then if therapy is needed 90833? If the ARNP asks questions about how the meds are working and then takes 30 minutes for counseling how should this be coded. I'm unsure if the ARNP is completing the proper documentation to bill a E & M code. Or if she should just bill for therapy. Is it required to use a E & M code because she writes scripts and ask how they are working. I guess I just don't see this happening every week or once a month. Sorry for the confusion I am struggling with coding this correctly.



Hello,

So I think in order to combine somewhat the previous posts, I am going to (hopefully) shine some more light on this:

-What was the intent and purpose of the visit? If the intent was to receive psychotherapy and a prescription was done, then an E/M + 90833 could be appropriate. In my state, only psychiatrists can do this though, and I am not sure which regulations your state have.   
-If still yes, then be aware of the time units. If the total time was 30 minutes, this time should have gone towards 90833 and not the E/M; or vice versa. You cannot double dip with time.
-If the patient was in here for management of their behavioral health conditions and the ARNP wrote up a script, then a regular E/M could work instead. The three E/M components (History, Exam and/or MDM) would determine the E/M level, unless Time was properly documented as an overriding factor.


Hope this clears up your confusion instead of adding to it.

If still confused, could you go into more detail of the note itself? I think that's where the main hang up lies with those trying to help.


----------

