Wiki Billing Psychotherapy codes in a PCP office

[amyrepp]

Hello,

We are seeking advice on billing psychotherapy codes in the PCP office for the 30 day follow up visit for our ADD/ADHD patients. Can a non-mental health provider bill for these codes for reimbursement?

Thank you,
Amy Repp
Pediatric Consultants of Troy

 

[HBULLOCK]

I'm not sure how that works with Psych codes. I work in a pediatrics office and we use the E/M codes for ADD/ADHD followups. I don't have any issue getting them paid. Hope that helps.

 

[Aapcli]

Hello, does anyone know of any additional codes outside of the usual 99213/4/5 that a pediatrician can use for ADD/ADHD follow ups? We have a capitated insurance that won't pay for the codes I mentioned and my rep suggested I use 99401, but that doesn't seem to make sense. Any help or suggestions would be appreciated!

 

[SharonCollachi]

If you're getting a capitation payment for the patient being on your census anyway... are you seeing them more than once per month?

99401 doesn't fit what you're doing; it's not a preventive medicine service. The CPT book specifically tells you to use E&M codes for medication management (99201-99215, etc.), when there is no psychotherapy involved.

Something to think about also, check to see if the patient has a mental-health carve-out to another insurance plan, and also check to see if your provider contract allows you to bill for mental health codes. Some contracts restrict mental health codes (either CPT or ICD10) to providers with a mental health specialty.

 

[Aapcli]

Thanks for the reply!
We are not seeing them more than once a month however our monthly capitation payments per patient are not even close to what we would be paid from our Medicaid managed care patients for the same visit. Thank you for the tip about checking our contact, I'll do that!