Wiki Psychiatry initial in office consultation

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kgittemeier

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I am new to Psychiatry billing, I have a seasoned Psychiatrist who keeps telling me he has only been billing 90792 for his initial 90min in office consultation. I do not think that is right and am wondering why I am not also billing a 99205. I am guessing at his previous practice his coders were correcting his coding before sending it out the door. Any help I can get will be appreciated.

His 1 hour follow ups I am billing a 99214 with 90838 which is a higher bill than the initial intake/consult.
 
The provider is billing correctly. You shouldn't bill something a certain way just because it pays more. E&M w/ Psychotherapy should not be performed on the initial visit. First visit is 90791 or 90792 and per the CPT instructions you cannot bill and E&M or psychotherapy code on the same day as the intake.

How are you selecting your E&M level? What makes you think 99205 is appropriate over a 99201-99204? I'm just trying to make sure you are not picking codes based off time or more money as your criteria.
 
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I agree with the previous reply and would like to add that the initial visit can be coded as a psychiatric evaluation (90792) OR an E/M visit for a new patient. You cannot bill both. For the psychiatric evaluation, you need to comply with documentation guidelines that include a complete history and a comprehensive mental status exam per the 1997 Documentation Guidelines for the specialty exam as well as set out a treatment plan and include medical management such as prescriptions. To bill the E/M visit you must meet the criteria for all three elements for the level being billed. Be very careful if you are using time for E/M services in mental health. E/M services based on time need to comply with the greater than 50% of the total time in counseling and coordination of care rule. Guidelines state that the counseling and coordination of care are in regards to medical concerns such as education on medications NOT therapy. To bill an E/M service with therapy, you must meet all requirements for the E/M level (and you cannot use time in this instance) PLUS the time requirement in the description of the therapy add-on code.

There is very good information on how to code mental health services, with examples, on the websites for the American Academy of Child and Adolescent Psychiatry as well as the American Psychiatric Association.
 
Perfect, with an ortho background I am very! unfamiliar with these codes. But very clear when broken down. Thanks all!!
 
Psychotherapy follow-ups

I had stated before for 1 hour follow up visits for psychotherapy, my physician has been billing a 99214 with a 90838. He also 99% of the time runs over close to 15/20 minutes. Looking at the therapy billing chart from the American Academy of Child and Adolescent psychiatry I see that coding is correct. If he bills for the psychotherapy alone it would be a 90837.
My current concern is that the billing for a 90792 ($293.98) is dramatically less than the follow up 99214 & 90838 ($422.98). I have been encountering a number of patient complaints regarding this. I am looking for any thoughts on this.
 
If you are going to use the 99214 and the 90838, then you need the documentation to be completely separate. You must show a 99214 not based on time but based on the key components of history, exam, decision making. Then you need the counseling portion timed separately. If the entire visit is counseling then you can only use the counseling codes.
If your provider runs over the 1 hour.. Then you cannot bill extra until the time over the one hour is 30 minutes or more, then you may add on the 99354.
 
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