aguelfi
Guest
This question is coming up to me again - and maybe someone can tell me how to bill.
Our patients are being assessed for cognitive issues, often have behavioral issues as well. Most patients are seen with at least one caregiver. It is not unusual for the visit that I will describe to have several local family and other out of town family on conference call.
Example:
Patient (and caregivers in most cases) sees MD at conclusion of the evaluation process - all testing is reviewed with patient (i.e MRI, Neuropsychological testing summary, labs etc.) diagnosis and medical recommendations are provided - actual face time for our example 30 minutes.
Physician leaves room.
Patient (and caregivers) sees PhD or LCSW who reviews the patterns of cognitive loss, safety issues and care needs, suggests educational programs, specific support groups, level of care and provides specific referral information to supportive services. This could include, in-home care, Day Care Assisted living etc. Often issues such as stress reduction, communication and care techniques and family issues relating to care are discussed etc. - actual face time in our example 30 minutes.
Total time for appointment 60 minutes - 2 professional used (both with Medicare provider numbers). How would we most appropriately be reimbursed for this type of service??
I have previously stated to the providers that according to the CCI edits, these codes are bundled together so other providers doing this must be attaching a 59 to the E&M 99201-99499 code. That is the only way I see that they would be paid together. According to the CPT assistant, May 2005It states, “If services are provided on the same day for those patients who do require psychiatric services (90818-90899) as well as health and behavior assessment or intervention, only the predominant service codes should be reported. The counseling and/or risk factor reduction intervention codes (99401-99429) should not be reported on the same day as the health and behavior assessment or intervention codes (96150-96133). Additionally, evaluation and management service codes (99201-99499) should not be reported on the same day as the health and behavior assessment or intervention codes.
my providers states others are doing this and I don't know what else to tell her.
Thanks so much for any help you can offer.
Our patients are being assessed for cognitive issues, often have behavioral issues as well. Most patients are seen with at least one caregiver. It is not unusual for the visit that I will describe to have several local family and other out of town family on conference call.
Example:
Patient (and caregivers in most cases) sees MD at conclusion of the evaluation process - all testing is reviewed with patient (i.e MRI, Neuropsychological testing summary, labs etc.) diagnosis and medical recommendations are provided - actual face time for our example 30 minutes.
Physician leaves room.
Patient (and caregivers) sees PhD or LCSW who reviews the patterns of cognitive loss, safety issues and care needs, suggests educational programs, specific support groups, level of care and provides specific referral information to supportive services. This could include, in-home care, Day Care Assisted living etc. Often issues such as stress reduction, communication and care techniques and family issues relating to care are discussed etc. - actual face time in our example 30 minutes.
Total time for appointment 60 minutes - 2 professional used (both with Medicare provider numbers). How would we most appropriately be reimbursed for this type of service??
I have previously stated to the providers that according to the CCI edits, these codes are bundled together so other providers doing this must be attaching a 59 to the E&M 99201-99499 code. That is the only way I see that they would be paid together. According to the CPT assistant, May 2005It states, “If services are provided on the same day for those patients who do require psychiatric services (90818-90899) as well as health and behavior assessment or intervention, only the predominant service codes should be reported. The counseling and/or risk factor reduction intervention codes (99401-99429) should not be reported on the same day as the health and behavior assessment or intervention codes (96150-96133). Additionally, evaluation and management service codes (99201-99499) should not be reported on the same day as the health and behavior assessment or intervention codes.
my providers states others are doing this and I don't know what else to tell her.
Thanks so much for any help you can offer.