# When to bill E&M codes for Mental Health



## anja.aplan@state.sd.us (Jan 14, 2014)

The CPT book is not very specific when it comes to explaining when a mental health provider should bill a E&M code.  When should a mental health provider bill an E&M code instead of a psychotherapy code?  It seems like a lot of them are switching to the E&M codes.  Any help is appreciated.  Thank you.


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## ccmiller0318 (Feb 4, 2014)

*When to bill E&M for mental health*

I wanted to add to the previous post...can a psychologist bill E&M codes?  I have a provider that is embedded into a medical practice and will see patients leaving their MD office and then directly seeing the psychologist related to a mental health condition.  Our provider is not providing counseling but a consult that would require interaction with the patients parent and with the PCP.


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## ahefner (Feb 6, 2014)

Medicare had a wonderful article on this in their MLN Matters that I read just today. Here is the link
http://www.cms.gov/Outreach-and-Edu...k-MLN/MLNMattersArticles/downloads/SE1407.pdf
 A psychologist can not bill for evaluation and management codes. I hope that this article will give you some clarity!
Andrea Hefner, CPC
President, Fort Walton Beach Local Chapter


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## jcochran (Mar 4, 2014)

anja.aplan@state.sd.us said:


> The CPT book is not very specific when it comes to explaining when a mental health provider should bill a E&M code.  When should a mental health provider bill an E&M code instead of a psychotherapy code?  It seems like a lot of them are switching to the E&M codes.  Any help is appreciated.  Thank you.



Only psychiatrists can bill for E/M codes.  E/M is what the psychiatrists use for their medication management of the client. They will choose the E/M level based on the specifics of each different client.  If the psychiatrist is using therapy also, that is an add on code, 90833, 90835, 90838  

For psychologists, they will use the codes 90791-intial, then 90832, 90834, 90836for therapy. 

Hope this helps.


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## mitchellde (Mar 4, 2014)

ahefner said:


> Medicare had a wonderful article on this in their MLN Matters that I read just today. Here is the link
> http://www.cms.gov/Outreach-and-Edu...k-MLN/MLNMattersArticles/downloads/SE1407.pdf
> A psychologist can not bill for evaluation and management codes. I hope that this article will give you some clarity!
> Andrea Hefner, CPC
> President, Fort Walton Beach Local Chapter



That particular transmittal has been rescinded.  In 2013 the AMA revised the definition of provider for the E&M codes.  These codes can be used by any qualified healthcare professional and does include the PhD as well as Masters level therapist as long  they have their own billing number.


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## anja.aplan@state.sd.us (Mar 10, 2014)

Thanks for the help!


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## mhstrauss (Mar 21, 2014)

mitchellde said:


> That particular transmittal has been rescinded.  In 2013 the AMA revised the definition of provider for the E&M codes.  These codes can be used by any qualified healthcare professional and does include the PhD as well as Masters level therapist as long  they have their own billing number.



Debra,

This statement is incredibly useful to me, as we are having a big issue with this in my clinic.  I have several Neuropsychologists who do have prescriptive privileges (under Louisiana law), and I have been unable to figure out how to code when they do med management only at an appt.  I completely understand the use of the psychotherapy codes, as well as the 90863 add-on code for med management when performed along with therapy, but I could never find a code for med management only, and I was told they could not use the E/M codes because they are not medical providers.  So the statement I'm seeing in the 2013 CPT book "physician or other qualified health care professional is an individual who is qualified by education, training, licensure/regulation, and facility privileging who performs a professional service within his/her scope of practice and independantly reports that professional service"....I can interpret that to mean that since these psychologists have additional training that allows them to write prescriptions, they are allowed to bill E/M codes?  

I really appreciate any input you (or anyone else!) will give.

TIA!!


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## ahefner (Jul 23, 2014)

mitchellde said:


> That particular transmittal has been rescinded.  In 2013 the AMA revised the definition of provider for the E&M codes.  These codes can be used by any qualified healthcare professional and does include the PhD as well as Masters level therapist as long  they have their own billing number.



I can not find where this statement was rescinded. I am on the APA (American Psychological Association) website and the most recent guidance I see is this - 
Pharmacologic Management
Of particular interest to prescribing psychologists, a new add-on code 90863 will be used for pharmacologic management, including prescription and review of medication, when performed with psychotherapy services. A psychologist providing a psychotherapy service with medication management should report the 90863 add-on code along with the applicable new psychotherapy code identified above.
Prescribing health care professionals who provide evaluation and management (E/M) services as well as psychotherapy will also have the following options, depending on the type of service delivered. They will report an E/M code along with a psychotherapy add-on code if both E/M and psychotherapy are provided, or they will simply report an E/M code if only E/M is provided.
http://www.apapracticecentral.org/reimbursement/billing/psychotherapy-codes.aspx
I believe that almost all other specialities have an exception to billing E/M but psychologist don't seem to be one of them. 
That all being said it seems inconsistent to me that the APA is saying to bill the add on code of 90863 in addition to psychotherapy such as 90834. I don't see that being approved. 
Could you please provide the documentation showing that psychologists can bill E/M??? I am suspecting that this would be limited to psychologists with prescriptive authority!


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## twetea81 (Nov 1, 2016)

*psychologist only codes*

I have read the following post and would like clarity for anyone that can help. If a psychologist is evaluating a patient it is okay to use 90791 with additional  psychotherapy codes, 90832, 90834, or 90837?


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## tehorst (Dec 19, 2016)

*Psychologist CANNOT bill E&M and 90791 CANNOT be billed with psychotherapy*

Per CPT guidlines "Report psychiatric diagnostic evaluation codes 99791 and 99792 for the initial diagnostic assessment and subsequent reassessments when medically necessary. These codes are reported *only when no psychotherapy services are performed on the same date of services.* For ongoing diagnostic assessments performed with psychotherapy services, refer to codes 90832-90938, 90839-90840."

Psychologists are NOT permitted to bill E&M codes. E&M are for medical services and not within their "scope of practice".

19. Which practitioners are allowed to use E/M codes?
Physicians and Non-Physician Practitioners (subject to state scope of practice laws). Nonphysician
practitioners include:
• Nurse practitioners;
• Clinical nurse specialists;
• Certified nurse midwives; and
• Physician assistants 
https://www.thenationalcouncil.org/wp-content/uploads/2013/06/NC-CPT-FAQ-for-2013-V3.pdf

Can prescribing psychologists use E/M codes?
No, that is why code 90863 was created.
.....
90863 is only for use by those few psychologists licensed to prescribe... but who, as nonmedical clinicians, are not qualified to bill evaluation and management codes. 
......
the rationale behind the development of that code was to accommodate those few psychologists who could prescribe, but by law cannot bill an E/M service."
https://www.psychiatry.org/psychiat...-and-reimbursement/frequently-asked-questions


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