Wiki Billing telephonic sessions for Psychiatrists and APNP

nwhite123

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Hi there!
With the recent Medicare updates (4/30/2020) approving the behavioral health therapy CPT codes (90832-90838, etc) for telephonic sessions has removed a ton or weight from our shoulders but now we are stuck in how to bill these services for our psychiatrists and APNP's whom normally bill E/M code + add on (EX: 99214 +90833). The E/M codes are not listed as approved cods for telephonic sessions but the therapy add on codes are. How do we proceed woth billing for their services? Would we bill 99443 + the therapy add on (Ex: 99443 +90833)?
Thank you for youtime and assistance with my questions!
 
Thank you for your response!!!
Can you tell me if we bill the 99441-99443 phone codes with the therapy add on codes (90833/90836/90838) for the telephonic sessions?
 
Thanks you once again Sharon for your response. I am sorry but have one more thing....
I did not think we could bill our regular E/M codes (99211-99215) for telephonic (audio only sessions) sessions because they are not listed on the Medicare approved codes for telephonic only codes: https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes

I know we can bill the 99211-99215 for telehealth (audio + visual) but I did not think we could for telephonic (audio only) sessions. We are trying to figure out how to bill those services for the E/M + therapy for phone only.

Once again, THANK you so much for your responses!
 
Uggh, sorry. Some insurances are allowing phone-only (no video) and some are not.

Those add-on codes cannot be billed as an add-on to a phone call, which makes no sense, as the add-ons ARE approved for audio only, but none of the codes listed to as the main code are approved for audio only!

You may have to do therapy on a different day, and use 90832 instead of 90833.
 
CMS requires audio AND real time video for telehealth billing E/M services modifier 95 (for telehealth) and POS it is normally done in. If the provider does telephone audio only use the telephone E/M codes only for practitioners that can perform E/M services. These are time based codes be sure your providers are documenting total time. 99441-3 . Also be sure to read the guidelines because the it can not lead to E/M service with 24 hours or next available and can not be related to an E/M service that was performed in the prior 7 days. The good news is CMS has aligned the reimbursement on these telephone codes to established E/M RVU's and reimbursement. On another note, not knowing what state you are in, but I am in NH and due to the state legislature the commercial payers are not requiring video for telehealth E/M visits. So check your payers.
 
I live in Madison , WI. I just find it confusing that Medicare would allow the add on therapy codes (90833; 90836 and 90838 ) for audio only but will not allow the E/M codes to go with it AND you cannot bill those therapy add on codes with the phone approved codes (99441-99443).
Unfortunately our two biggest payers are following MC guidelines so it is not much help for us.
I appreciate your responses back to my inquiry and would appreciate any other insight you can give me!
 
Have you guys seen this release from the APA:

Telehealth
APA has a page dedicated to Telepsychiatry and COVID-19. Key guidance for the duration of the emergency declaration includes:
• New CMS Changes to Billing for Audio Only – Retroactive to March 1, 2020 - Updated 5/11
o On April 30, 2020, CMS issued a new ruling permitting audio only telephone care for the following psychiatry codes: 90785, 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 90839, 90840, 90845, 90846, 90847, 90853. The psychotherapy add-on codes are to be used with the E/M telephone codes, 99441,99442, and 99443. CMS also announced they will increase payments for these E/M codes to match payments for similarly timed office and outpatient visits. Payments for these services have increased from the current range of about $14-$41 to the higher range of about $46-$110, and these payments are retroactive to March 1, 2020.
o When billing these services in addition to a psychotherapy service (90833, 90836, 90838), divide the time spent between the two codes according to the work performed, taking care not to count the same minute twice. And be sure to document the time spent on each service accordingly.
o Anyone providing care via audio AND video will continue to bill as they have been using the traditional E/M codes (see below – clarification on billing Medicare telehealth) with the 95 modifier.
• Clarification on billing Medicare for telehealth: When conducting a telemedicine encounter:
o By audio and video: use the same CPT codes as if the encounter were in-person
o By audio only: use any of the psychiatric services identified in the following list: 90785, 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 90839, 90840, 90845, 90846, 90847, 90853. E/M services should be reported using the telephone E/M codes (99441-99443).
o For all telehealth services use the Place of Service (POS) that aligns with where your encounter would have occurred
o For new telepsychiatry encounters (both audio and video as well as audio only) provided to patients under the waiver that would have been office visits, psychiatrists should consider their office as the place of service (POS) and use the place of service code 11, just as you did when you were seeing your patients in person. If you are providing inpatient care, you should use the place of service you would ordinarily use for that place even though you are not actually there. You should use the same CPT codes you would use for an in-person encounter, and on the 1500 Claim Form you should add the modifier 95 after each CPT code to indicate the care was provided as telemedicine. These same directions should be applicable for most commercial payers as well. Please let APA know if your experience is different.
o Those psychiatrists who were previously providing telepsychiatry under Medicare's pre-waiver rules should continue to report this care as they always have with POS 02.
o For more information on telepsychiatry during COVID, see our Telepsychiatry blog.
• CMS released guidance on March 17, 2020, that allows patients to be seen via live videoconferencing in their homes, without having to travel to a qualifying "originating site" for Medicare telehealth encounters, regardless of geographic location.
• The Office of Civil Rights (OCR) has indicated they will exercise enforcement discretion and waive penalties for HIPAA violations against health care providers that serve patients in good faith through FaceTime or Skype.
• The Medicare coinsurance and deductible would generally apply to these services. However, the HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.
• The Ryan Haight Act requires that a provider conduct an initial, in-person examination of a patient—thus establishing a doctor-patient relationship—before electronically prescribing a controlled substance. As of March 17, 2020, the DEA has indicated that this requirement has been suspended.
• The American Professional Agency, Inc, which provides professional liability malpractice insurance, developed resources to help members, specifically issued an FAQ about Coronavirus and Telehealth and Coronavirus and Telehealth Resources.
 
Does anyone know how to bill the add on therapy codes (90833; 908386; 90838) for audio only sessions (they are approved by MC) but the typical E/M codes (99211-99215) are note approved for audio only.
 
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