Psychiatry Coding & Reimbursement Alert

Question: In our practice, a physician sees a patient and then the patient is sent to another clinician for psychotherapy. I am confused. Do I need to report an E/M code and an appropriate standalone psychotherapy code for the encounter, or should I report the E/M code with an add-on psychotherapy code?

Virginia Subscriber

Answer: In general, you can report an E/M service with add-on psychotherapy codes (+90833, +90836 or +90838) for the patient only if both services were provided by the same clinician.

For example, if your psychiatrist performs pharmacological management and provides psychotherapy for the patient during the same session, then you will report an appropriate E/M code for the encounter. Be sure to include the appropriate add-on code based on the time your clinician spent in providing psychotherapy.

However, in your case, because these two services were provided by different clinicians, you cannot report the E/M code with add-on psychotherapy codes. Instead, you will have to report the E/M service with an appropriate E/M code and the psychotherapy with the appropriate standalone psychotherapy code (90832, 90834 or 90837) based on the time spent by your clinician on providing psychotherapy.

As the services were provided by two clinicians, you should typically submit two independent claims providing their individual national provider identifier (NPI) for the appropriate claim. In other words, you would use the physician’s NPI for the E/M service, and you would use the other clinician’s NPI for the standalone psychotherapy.

Watch out: If both the services are claimed under one NPI and claimed together, then you will face denials for the services provided.

A possible exception is the situation in which the two services are provided by different clinicians of the same specialty in the same group practice. For example, one psychiatrist in a group provides the E/M service, and another psychiatrist in the same group provides the psychotherapy. Many payers treat physicians in the same group practice as if they were just one physician, especially if they bill under a group tax identification number and are the same specialty. Section 30.6.5 of chapter 12 of the Medicare Claims Processing Manual typifies this approach, “Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician.” Section 30.6.5 goes on to say, “Physicians in the same group practice but who are in different specialties may bill and be paid without regard to their membership in the same group.”