rhotonscott
Networker
I've worked as a Psych Coder for a Community Mental Health Center for a numver of years. We have both prescribers doing medication management and clinicians doing therapy. Often our clients have both their prescriber (E/M) visit and their clinical (psychotherapy) visit same-day. It makes sense clinically as getting clients with severe mental illness to come into the office is difficult enough, so doing both visits same-day helps with treatment. Problem is, NCCI edits do not allow this unless the psychotherapy is done as add-on code to the E/M visit-I have written and spoke to many learned folks on this subject, and the concensus is that only the prescriber or other prescribers can use the add-on code with the E/M visit.
Per CPT: Some psychiatric patients receive a medical evaluation and management (E/M) service on the same day as a psychotherapy service by the same physician or other qualified health care professional. To report both E/M and psychotherapy, the two services must be significant and separately identifiable. These services are reported by using codes specific for psychotherapy when performed with evaluation and management services (90833, 90836, 90838) as add-on codes to the evaluation and management service.
Question: Do clinicians (therapists) qualify as "other qualified health care professional" and can I use add-on code (90833,90836, 90838) when they do same-day therapy as E/M service (99212-99215). The assumption is that it is within the scope of their practice and they are credentialed for the the insurer billed
Per CPT: Some psychiatric patients receive a medical evaluation and management (E/M) service on the same day as a psychotherapy service by the same physician or other qualified health care professional. To report both E/M and psychotherapy, the two services must be significant and separately identifiable. These services are reported by using codes specific for psychotherapy when performed with evaluation and management services (90833, 90836, 90838) as add-on codes to the evaluation and management service.
Question: Do clinicians (therapists) qualify as "other qualified health care professional" and can I use add-on code (90833,90836, 90838) when they do same-day therapy as E/M service (99212-99215). The assumption is that it is within the scope of their practice and they are credentialed for the the insurer billed