Wiki Coding question

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happycoder07

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Good morning,

Are the list of providers below allowed to bill the CPT E&M codes shown here? Are there any stipulations? Thank you.

Providers:
Licensed Psychiatrist
Licensed Psychologist
Licensed Professional Counselor
Licensed Clinical Social Worker


CPT Codes: (E&M Codes)
99201
99202
99203
99204
99205
99211
99212
99213
99214
99215
 
None of these providers can bill E&M codes to Medicare. Other payers may offer exceptions.

Medicare will only reimburse E&M services (other than physicians) for a nurse practitioner (NP), clinical nurse specialist (CNS), a certified nurse midwife (CNM) or a physician assistant (PA).
 
Psychiatrists can bill those codes, as they are MDs (or DOs).

The stipulation is to bill to the highest level of specificity. Since there are psych codes, usually the psych codes are more specific. When I worked for a psychiatrist, we billed one of those codes exactly one time. The patient was having some sort of medical emergency that was not psych-related, and the psychiatrist attended to her until the ambulance arrived.

For a long time, mental health providers other than psychiatrists (MD or DO) could not bill any code that had medical decision-making, as psychologists make mental health decisions, not medical decisions. I've been out of mental health for a little over 7 years now, and I haven't completely kept up on those things.
 
Yes, agreed, psychiatrists may bill these - I overlooked that on your list.

There's a great resource page on the American Psychiatric Association's web site just for coding, linked below. In particular, the PowerPoint presentation CPT Coding for Psychiatric Care in 2014 is very good and I've actually used it as education material to help train BH physicians in coding.

 
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