Wiki Billing for Depression

[khumphries]

Our primary care physician's office treats a lot of depression. Medicare has recently begin applying a psychiatric reduction to our claims. We file E/M 99213 most of the time. I am curious how other PC offices bill depression. I am fairly new to coding so I would appreciate any information.

Thank you

 

[kbarron]

Because of the dx code in the primary position.

 

[jdrueppel]

I bill anesthesia for ECT (electroconvulsive therapy) services. Whenever the service is outpatient (POS 22) Medicare applies the 50% mental health reduction. When inpatient (21) this reduction is not applied. I didn't know that this reduction was also applied to office visits with a mental health dx- good to know - so it's not just the diagnosis but also the place of service that drives the reduction. It has been my experience that, on assigned claims, MOST supplemental insurance carriers pay the full balance remaining after Medicare payment.

Hope this helps.

Julie, CPC

 

[khumphries]

Thank you - very helpful

 

[S Avara CPC]

I've always seen this reduction take place if the depression or anxiety diagnosis is listed as the primary diagnosis.

 

[KristieStokesCPC]

We get down coded as well and it's really frustrating. I also noticed on one of my last EOB's that we were down coded for a headache....