jillmoore1355
New
We are bringing on a psych NP and she will be billing mostly 99214 and 99215. How do you do E/M codes with that; especially with indicating time. Does that need to be a 60 minute appointment?
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Wiki 99214 With E/M Codes
- Thread starter jillmoore1355
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jkyles
True Blue
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Hi there, I would be extremely wary of predicting the level of service a provider is going to perform.
As to the time question: If you review the guidelines for time-based coding you'll see that that provider can count time for several activities related to the patient visit that happen on the calendar date of the visit. So it is unlikely that you'd just count appointment time.
As to the time question: If you review the guidelines for time-based coding you'll see that that provider can count time for several activities related to the patient visit that happen on the calendar date of the visit. So it is unlikely that you'd just count appointment time.
E/M leveling is a visit by visit basis, so you can't really predict that someone will be billing mostly 99214 and 99215. (Certainly some specialties have an average curve that leans more towards the higher level visits, given the nature of the specialty, but that's not an exact prediction.)
Also, for time based coding, remember that the medical record and reason for the visit needs to substantiate the time billed for the day. The provider's time still needs to be medically appropriate.
(I'm sure you're aware of that, of course, but I just wanted to add the general disclaimer for anyone reading that providers can't just bill a long visit for the sake of getting a higher level E/M paid. If a provider is billing outside the typical level distribution for their specialty, it may be a red flag that catches the attention of auditors to dig a little deeper into what's going on with that provider.)
jkyles is correct that time for additional activities on the calendar date of the visit can be included towards time for E/M leveling purposes.
ckeeney
Guru
I just wanted to add that when billing E&M visits using time in the behavioral health world, any psychotherapy provided during the same visit is not included in the time for the E&M but rather needs to be separately documented and the add-on psychotherapy codes used. Times for both services need to be distinguished and not overlap in any way (no double-dipping). In the visits that include psychotherapy, even if using MDM for the E&M portion, the time for psychotherapy needs to be documented as they are time-based codes.
amyjph
True Blue
In reading your question I was wondering if you meant how do you code E/M with the psychotherapy codes? "she will be billing mostly 99214 and 99215. How do you do E/M codes with that" Did you mean to say how do you code E/M with codes like 90832-90837? There are different codes depending on with or without medical E/M services.
I agree with the advice above and also being careful not to automatically assume a provider will "always" be billing level 4 or 5.
Some info:
www.apaservices.org
https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00026768 (not your MAC but an example)
E/M services performed on the same day as a psychotherapy service (same physician or other health care professional) must be significant and separately identifiable in order to bill both psychotherapy and E/M.
I think the date on this is older so the codes may not be 100% but something like this and a current date would be helpful for understanding.
Back in 2014 there was a CERT report on it from CMS: https://www.cms.gov/research-statis...refeeforservice2014improperpaymentsreport.pdf
~Psychiatry and Psychotherapy Services. The improper payment rate for psychiatry and psychotherapy services was 28.7 percent, accounting for 0.6 percent of the overall Medicare FFS improper payment rate. The projected improper payment amount during the 2014 report period was $316.2 million. The majority of improper payments for psychiatry and psychotherapy services were due to insufficient documentation. The time spent providing psychotherapy determines thepsychotherapy code. Providers must clearly document in the beneficiary’s medical record the time spent providing the psychotherapy service rather than entering one time period also including an E&M service. Example - The provider billed HCPCS 90833 - psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service. Initial documentation received was a progress note for the billed date of service that was missing documentation of time spent during the encounter. Following additional documentation requests for documentation of time spent during the encounter and the treatment plan (containing frequency& duration of treatment as well as measurable goals), no additional documentation was received. The submitted documentation was insufficient to support the services billed. The CERT program scored the claim an improper payment due to an “insufficient documentation error.”
I agree with the advice above and also being careful not to automatically assume a provider will "always" be billing level 4 or 5.
Some info:
Psychotherapy codes for psychologists
All mental health professionals including psychologists, psychiatrists, nurses and social workers delivering psychotherapy services use the same applicable CPT codes when billing clients and filing health insurance claims with third-party payers.
www.apaservices.org
https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00026768 (not your MAC but an example)
E/M services performed on the same day as a psychotherapy service (same physician or other health care professional) must be significant and separately identifiable in order to bill both psychotherapy and E/M.
I think the date on this is older so the codes may not be 100% but something like this and a current date would be helpful for understanding.
Back in 2014 there was a CERT report on it from CMS: https://www.cms.gov/research-statis...refeeforservice2014improperpaymentsreport.pdf
~Psychiatry and Psychotherapy Services. The improper payment rate for psychiatry and psychotherapy services was 28.7 percent, accounting for 0.6 percent of the overall Medicare FFS improper payment rate. The projected improper payment amount during the 2014 report period was $316.2 million. The majority of improper payments for psychiatry and psychotherapy services were due to insufficient documentation. The time spent providing psychotherapy determines thepsychotherapy code. Providers must clearly document in the beneficiary’s medical record the time spent providing the psychotherapy service rather than entering one time period also including an E&M service. Example - The provider billed HCPCS 90833 - psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service. Initial documentation received was a progress note for the billed date of service that was missing documentation of time spent during the encounter. Following additional documentation requests for documentation of time spent during the encounter and the treatment plan (containing frequency& duration of treatment as well as measurable goals), no additional documentation was received. The submitted documentation was insufficient to support the services billed. The CERT program scored the claim an improper payment due to an “insufficient documentation error.”
jkyles
True Blue
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I would just add that owning and reviewing the most recent CPT manual is essential to correct coding. Free information can be very helpful, but it may be out of date. Coders must use the current codes and guidelines and those may be updated from year to year.