Wiki ADD/ADHD Consults

[sjenrette]

I had a meeting with my providers and a question came up about when they have add/adhd evaluations. They wanted to know if they are allowed to charge a 99213 even though they did not exam the patient. I told them let me get some advice and I will let you know. I thought about it last night and I thought they could because to charge a 99213 as long as the have 2 of the 3 components it is possible. If they have an expanded problem focused history and a medical decision making of low complexity. Any opinions on this?

 

[Cynthia Hughes]

ADHD follow-up without exam

I had a meeting with my providers and a question came up about when they have add/adhd evaluations. They wanted to know if they are allowed to charge a 99213 even though they did not exam the patient. I told them let me get some advice and I will let you know. I thought about it last night and I thought they could because to charge a 99213 as long as the have 2 of the 3 components it is possible. If they have an expanded problem focused history and a medical decision making of low complexity. Any opinions on this?

My thoughts. First, be sure your physicians are not short changing themselves on the examination. They are likely providing at least a problem-focused examination (e.g., brief assessment of mental status). A problem-focused psychiatric examination requires 1-3 elements identified by a bullet in the 1997 exam which could include measurement of three vitals (necessary for monitoring for effects of ADHD medication), attention span and concentration, mood and affect, and/or description of patient's judgment and insight. Though, CPT allows selection of the established patient office visit codes based on two of three key components, payers may want to see some level of examination to support that there was a face-to-face encounter.

However, often the majority of time spent face-to-face with the ADHD patient is spent in counseling and/or coordination of care. Documentation of the face-to-face time, amount or percentage of time (greater than 51% of the face-to-face encounter), and details of the counseling/coordination activities may support a higher level of E/M code than that supported by the three key components. Be sure to identify payer policies regarding billing E/M services based on time (e.g., must the typical time be met or exceeded or is CPT guidance on time followed).

I hope this helps. Cindy