Wiki Counseling visit for pysch

[veloso]

Hi to All,
Our NP Pysch asked me that some patients will just schedule with her for some Counseling and some times she will give Rx so my question?
1.)If we could use the E/M 99211-99215 based on Time BUT not any Psych Codes I just wonder if we will get reimbursed?
2.)If encase she will give Rx if we could bill EX:Both=99212 and 90862?

Thanks

 

[jackson7591]

Reference

http://www.wpsmedicare.com/part_b/policy/active/local/l30489_psych014.shtml

Time based coding does include instances where counseling or coordination of care occupies more than half the visit or reults in prolonged services for an e/m coded outpatient or inpatient encounter. However, and please anyone jump in and correct me, e/m codes must meet the need for medical necessity in these cases. I'm not familiar with psych coding and meeting medical necessity reqired for time based coding.

Also, according to he above reference, simply prescribing a medication does not seem to meet the qualifications for 90862. Certainly the provider must initially prescribe the medication. However, during follow up visits when therapeutic levels are measured, clinical effects are assessed and MDM regarding maintaining or adjusting dosage or even changing medications are when 90862 seems more appropriate.

A provider may document complex MDM when initially prescribing a medication with respect to existing complicating factors, possible drug interactions, or narrow therapeutic ranges requiring frequent drug level monitoring, or high risk side effects. But once these considerations are documented, the basis of the visit would seem to lean back to an code that is not time dependent?

Not trying to give a yes or no answer. Just thinking through your post with details that might help lead to an answer.

 

[veloso]

Hi Jackson,
For this particular NP she has all the documentations for all services that she billed for 90805,90862 'per se' all her Psych Codes her only concerned are the WALK-INS for 5-10 minutes approximately whom who just wants counseling and she is curious if these services are billable..especially sometimes she will gave them RX'S.


THANKS A LOT!

 

[jackson7591]

Walk-ins

My thinking is that some of these may be billable, but would be surprised if all of them. Reason being that if they are patient initiated, all may not meet medical necessity. And if you provider writes an initial Rx, medication management threshold would not seem to be met.

Can always advise pts that services might not be covered, bill at time of service, and submit appropriate codes to insurance, and reimburse pts as appropriate?

 

[abalkevitch]

I am having a similar problem. I thought 90805 included medical eval/management? Would billing it with a 90862 be considered unbundling?

 

[1073358]

I am having a similar problem. I thought 90805 included medical eval/management? Would billing it with a 90862 be considered unbundling?

You can not bill an EM with 90862 same day nor can you bill a 90805,90807, etc with a 90862. The 90862 is bundled into the EM part of the 90805