Wiki Psychiatrist Billing

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dogwhisperer36

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Maryland Heights, MO
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Hi There,

This may be a dumb question, but here goes. I have been billing for therapists (LCSWs, LPCs), and using the psychotherapy codes - 90853, 90837, 90834; etc.

I spoke with a psychiatrist today who wants me to start billing for him. He is currently billing E/M codes for his visits (99213, 99214). He says that he doesn't really do psychotherapy; that his visits are more medical management. Is this the norm for Psychiatrists?

Thank you,

Tara
 
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Hi DogWhisperer :)
Some psychiatrists do both. He will document the patient s chronic medical conditions such as G47, E11, I10, E55, J30, Etc. just link that with Eval Mgm CPT 99212-99214 but if pt comes in for behavioral health stressed visit such as dx F32, F41, Z63 or F06 I'd link that to CPT 90832 series.
Lady T
PS Are you really a dog whisperer ? Which dog breed is your favorite? By the way I adore dogs too!(y)
 
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TThivierge said:
Hi DogWhisperer :)
Some psychiatrists do both. He will document the patient s chronic medical conditions such as G47, E11, I10, E55, J30, Etc. just link that with Eval Mgm CPT 99212-99214 but if pt comes in for behavioral health stressed visit such as dx F32, F41, Z63 or F06 I'd link that to CPT 90832 series.
Lady T
PS Are you really a dog whisperer ? Which dog breed is your favorite? By the way I adore dogs too!(y)
Click to expand...
Hi Lady T,

Thank you for your response. These were my thoughts as well. This is an older psychiatrist, and I think we are going to have to sit down and have a coding chat. He's been using the E/M codes for everything because he's "always done it this way". And yes, he is still using paper charts.

Yes, I am a dog whisperer of sorts. I used to be a groomer, and would quietly talk to the dogs to try to keep them calm. The other groomers started calling me the dog whisperer. lol. Favorite breed to groom is definitely the poodle. Favorite breed to live with is a mutt. We had a possible cattle dog/jack russell/who knows what mix for 12 years and she was amazing.

Tara
 
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I code and bill for a mental health entity and a psychiatrist should use the E&M codes for med management visits. If they also do psychotherapy as part of the visit, it must be separately documented and billed with psychotherapy add-on codes. Our psychiatrists rarely do therapy, only med management and bill E&M codes with the appropriate mental health diagnoses (ICD Chapter 5).

This from the CPT book at the beginning of the Psychiatry section (p. 731 in my book) "Psychiatry services include diagnostic services, psychotherapy, and other services to an individual, family, or group. Patient condition, characteristics, or situational factors may require services described as being with interactive complexity. Services may be provided to a patient in crisis. Services are provided in all settings of care and psychiatry services codes are reported without regard to setting. Services may be provided by a physician or other qualified health care professional. Some psychiatry services may be reported with evaluation and management services (99202-99255, 99281-99285, 99304-99316, 99341-99350) or other services when performed. Evaluation and management services (99202-99285, 99304-99316, 99341-99350) may be reported for treatment of psychiatric conditions, rather than using psychiatry services codes, when appropriate."
 
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Hi CKeeney,:)
Thanks for information. I guess the trick is to ensure the beh. health professional ( MD Psychologist LCSW LPC) documents time in each section on medical documentation /treatment for the day as medical illness vs. psyche illnesses portion with description and proper minutes on record plus assessments. Then enter all data on the claim format with proper dx & CPT linkage.. Does your practice list the modifier (AJ, AH etc )to define LCSW and LPC and psychologist on claims too?

Have a great day!!

Lady T
 
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TThivierge said:
Hi CKeeney,:)
Thanks for information. I guess the trick is to ensure the beh. health professional ( MD Psychologist LCSW LPC) documents time in each section on medical documentation /treatment for the day as medical illness vs. psyche illnesses portion with description and proper minutes on record plus assessments. Then enter all data on the claim format with proper dx & CPT linkage.. Does your practice list the modifier (AJ, AH etc )to define LCSW and LPC and psychologist on claims too?

Have a great day!!

Lady T
Click to expand...
Complicated question. Some payers allow LCSW, for example, to bill under their own name/credentials. In this case, no modifier. Our state Medicaid requires for mid-levels to be credentialed or bill under supervising with modifier. As far as time: our MD's do not usually do therapy. Documentation when they do should clearly indicated time for the med management visit and time for therapy. Our non-medical providers have their services billed on separate claims following payer rules for credentialing and supervising with modifier. Even if a psychiatrist does a med management visit on the same day as a therapy done by a mid-level we still file separate claims and, in the case where we file with supervising physician as rendering, the provider level modifier is usually enough to have the services go through as different providers.
 
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ckeeney said:
I code and bill for a mental health entity and a psychiatrist should use the E&M codes for med management visits. If they also do psychotherapy as part of the visit, it must be separately documented and billed with psychotherapy add-on codes. Our psychiatrists rarely do therapy, only med management and bill E&M codes with the appropriate mental health diagnoses (ICD Chapter 5).

This from the CPT book at the beginning of the Psychiatry section (p. 731 in my book) "Psychiatry services include diagnostic services, psychotherapy, and other services to an individual, family, or group. Patient condition, characteristics, or situational factors may require services described as being with interactive complexity. Services may be provided to a patient in crisis. Services are provided in all settings of care and psychiatry services codes are reported without regard to setting. Services may be provided by a physician or other qualified health care professional. Some psychiatry services may be reported with evaluation and management services (99202-99255, 99281-99285, 99304-99316, 99341-99350) or other services when performed. Evaluation and management services (99202-99285, 99304-99316, 99341-99350) may be reported for treatment of psychiatric conditions, rather than using psychiatry services codes, when appropriate."
Click to expand...
Our Agency will receive denials if our Psychiatric Providers assign any Medical diagnosis as Primary (with the exception of Substance Use disorder in a pregnant female where OB codes "OXX.XXX) are required by ICD 10 guidelines and possibly a few others that link the MH condition to the Medical problem. Psychiatrists and Psych Certified APN's are enrolled with payers as Mental Health providers and not under general Medicine. Primary Medical ICD-10's will be processed by the patient's Medical policy and the Provider type can result in a mis-match by payers. The primary diagnosis should always reflect a MH dx Primary and any co-occurring Medical conditions should be listed subsequently only if the provider addresses and is managing treatment for that problem. Our Psychiatric providers also do not typically perform additional psychotherapy services and provide medication management only (Outpatient E&M's 99213-99215). Our clients have a primary therapist that manages the psychotherapy portion of care. Be mindful to only report the diagnosis on claims that are addressed and managed within the documentation - we have many pre and post payment record requests from payers, if Dx reported are not supported in the note- refunds or denials are expected.
 
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Thanks for this forum. I also had a question regarding psychiatrist billing/supervision (apologies in advance if this is a basic question).
Question.....Can a psychiatrist sign-off notes for ACSW (associates) for billing, or can physicians only do so if there is a med management component involved? Or is it standard practice that the LCSW Supervisor (if one exists) sign-off on notes submitted? Thank you.
 
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CCat78
If LCSW is supervisor then puts statement on ACSW or QHP staff notation as proof reviewed can sign off, date it then bill it. Of course MD can sign off too, but their name listed on bottom of ACSW notes done after treating patient. Most time payers want modifier of HO and list who is attending MD provider or LCSW on claim.
I hope helped you
Lady T
 
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TThivierge said:
CCat78
If LCSW is supervisor then puts statement on ACSW or QHP staff notation as proof reviewed can sign off, date it then bill it. Of course MD can sign off too, but their name listed on bottom of ACSW notes done after treating patient. Most time payers want modifier of HO and list who is attending MD provider or LCSW on claim.
I hope helped you
Lady T
Click to expand...
Thank you, Lady T. This is helpful!
 
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What modifiers are required for psychological testing and individual psychotherapy, my providers are LPC, and LCSW . We know that the HO modifier would apply, are there any others that we should know about?
 
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TThivierge said:
CCat78
If LCSW is supervisor then puts statement on ACSW or QHP staff notation as proof reviewed can sign off, date it then bill it. Of course MD can sign off too, but their name listed on bottom of ACSW notes done after treating patient. Most time payers want modifier of HO and list who is attending MD provider or LCSW on claim.
I hope helped you
Lady T
Click to expand...
Thank you, Lady T once again for this earlier input. I did have another question (for you or the group too).
........Do you know if the reimbursement of the ACSW is different if the LCSW Sup signs versus the MD Physician? I'm thinking there would be a higher rate of reimbursement if MD signs-off ACSW, but I didn't want to assume. Thoughts?
 
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ccat78 said:
Thanks for this forum. I also had a question regarding psychiatrist billing/supervision (apologies in advance if this is a basic question).
Question.....Can a psychiatrist sign-off notes for ACSW (associates) for billing, or can physicians only do so if there is a med management component involved? Or is it standard practice that the LCSW Supervisor (if one exists) sign-off on notes submitted? Thank you.
Click to expand...
I would add that you need to check payer rules. Medicare, for example, does not allow billing under a supervising provider. Indiana Medicaid (the state I am billing for), has specific rules on supervising and modifiers for mental health services as well as who can be credentialed and bill. Most commercial payers do not allow billing under supervising and then credentialing is key, if required. All of our supervising is done by the psychiatrists although others such as HSPP's and LCSW's would be allowed by some payers. Medicare and Medicaid typically pay at 75-80% of what a psychiatrist or HSPP would receive.
 
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wskigirl said:
What modifiers are required for psychological testing and individual psychotherapy, my providers are LPC, and LCSW . We know that the HO modifier would apply, are there any others that we should know about?
Click to expand...
Wskgirl here are other modifiers to check are AJ=LCSW and AF specialty physician and AH clinical psychologist. I hope this helps you
Lady T
 
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dogwhisperer36 said:
Hi There,

This may be a dumb question, but here goes. I have been billing for therapists (LCSWs, LPCs), and using the psychotherapy codes - 90853, 90837, 90834; etc.

I spoke with a psychiatrist today who wants me to start billing for him. He is currently billing E/M codes for his visits (99213, 99214). He says that he doesn't really do psychotherapy; that his visits are more medical management. Is this the norm for Psychiatrists?

Thank you,

Tara
Click to expand...
 
0
Yes, since Psychiatrist are Medical Doctors , you will need to use E/M codes to bill for him. Starting with Initial Visit codes in the 99202 -99205 series then after that use the 99212-99215 series for established patients.
 
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TThivierge said:
CCat78
If LCSW is supervisor then puts statement on ACSW or QHP staff notation as proof reviewed can sign off, date it then bill it. Of course MD can sign off too, but their name listed on bottom of ACSW notes done after treating patient. Most time payers want modifier of HO and list who is attending MD provider or LCSW on claim.
I hope helped you
Lady T
Click to expand...
The Doctor or LCSW has to be an approved supervisor with the insurance company that you are billing.
 
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