Wiki Help!!! New cpt coding

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kerriej

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I have a question that I hope someone here might be able to help me with regarding the new codes for psychiatry... Now that you need to use an EM code and an additional code I am getting screws up on my payments. My software requires me to put a dollar amount for each code (unless I am missing a way to override this) I was hoping that if I put a price in. Each code the one would just automatically be unpaid as it is a bundled service BUT I started receiving double payments from the insurance company. HELP!!!! What is the proper procedure ???? Thank you!!!!
 
It is not double payment, the new psych codes have those that do not include E&M and are billed alone, and those that are add on to be billed with E&M. If your provider is doing psychotherapy and is also performing an E&M then you evaluate the E&M based on the 3 key components only no time, then he needs to document the start of the psychotherapy and it is best if her uses a start time to indicate that the E&M is not included in the time for the psychotherapy, as long as you have a minimum of 16 minutes of psychotherapy you have enough time to bill the add on psychotherapy code along with the E&M, then if there is documentation of interactive complexity you add that on as well and then if he documents a separate start time for medication management you can add that on as well. It is not double dipping if you bill it correctly and the documentation is constructed correctly.
 
Thank you so much for replying to my "situation." I am still unclear if I should be entering a dollar amount on the claim form for the EM code line and also the add on code line ??? Should I rec one payment amount or two???
 
You need a fee schedule for all the E&M codes as well as all the new psych codes. If this is an initial eval then you do not code an E&M in addition you just select the initial psych code that states includes eval and mgt. however for psychotherapy as I stayed you can code the E&M in addition to the add on psych code and possibly the interactive psych. You will have a dollar amt charge from your fee schedule for each line item you enter.
Let me know if you need further clarification . I can give exames once I get home and getting books out of my luggage.
 
You need a fee schedule for all the E&M codes as well as all the new psych codes. If this is an initial eval then you do not code an E&M in addition you just select the initial psych code that states includes eval and mgt. however for psychotherapy as I stayed you can code the E&M in addition to the add on psych code and possibly the interactive psych. You will have a dollar amt charge from your fee schedule for each line item you enter.
Let me know if you need further clarification . I can give exames once I get home and getting books out of my luggage.
 
Thank you sooooo much for your help!!! I am understanding it better now. I will happily accept any information you can offer me regarding this issue. Yes, if you can give me some examples would be great!!!! Where is the best place to look up information the fee schedule?
 
Is anyone getting denials when using the 99211-99215 E&M levels for pharmacological management? We are starting to seel denals when billing the E/M instead of 90862?
thanks,
 
dawn1170 said:
Is anyone getting denials when using the 99211-99215 E&M levels for pharmacological management? We are starting to seel denals when billing the E/M instead of 90862?
thanks,
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Wow, that makes no sense! Are you getting any explanation from the payer?
 
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