wgmarrs
Contributor
We're a community BH center who has added integrated primary care in our agency. We're encountering two difficulties in billing primary care E/M and psychiatry E/M. The first problem involves clients who see both a psychiatric and primary care provider on the same day, with an E/M being provided by each. Our understanding is that multiple E/M's on the same day are acceptable when a) two different providers are involved and b) the focal problem is different. Nevertheless we cannot seem to get both of the services paid. Our second problem involves the New and Established patient distinction. From our point of view, even though a client may be established psychiatrically, when they see the primary care provider for the first evaluation we feel they should be regarded as a New patient - because a different provider specialization is involved. But payers are denying these efforts by insisting the client is already established, based upon the psychiatric history.
I was wondering if any other BH provider has sojourned into the integrated care arena and had encountered any similar problems - and if so, whether any suggestions in resolving them may be at hand? TIA.
I was wondering if any other BH provider has sojourned into the integrated care arena and had encountered any similar problems - and if so, whether any suggestions in resolving them may be at hand? TIA.