lilleyea
Networker
Per the psychotherapy guidelines, when billing psychotherapy with an E/M, the E/M must be based on medical decision making. The actual guidelines state:
For the purposes of reporting, the medical and psychotherapeutic components of the service may be separately identified as follows:
1. The type and level of E/M service is selected based on medical decision making.
2. Time spent on the activities of the E/M service is not included in the time used for reporting the psychotherapy service. Time may not be used as the basis of E/M code selection and prolonged services may not be reported when psychotherapy with E/M (90833, 90836, 90838) are reported.
I understand that means that if an office visit or inpatient encounter is also performed with psychotherapy, the E/M level must be selected based on medical decision making. My question is what if a hospital discharge is performed with psychotherapy? The 2 codes 99238 and 99239 are based solely on time, MDM is not an option. 99238 and 99239 are both valid primary procedures for the add-on psychotherapy codes. How could 99238 vs 99239 be determined without the use of time? The guidelines state time may not be used as a the basis of E/M code selection when psychotherapy with E/M is reported, so how would 99239 be able to be reported with psychotherapy?
For the purposes of reporting, the medical and psychotherapeutic components of the service may be separately identified as follows:
1. The type and level of E/M service is selected based on medical decision making.
2. Time spent on the activities of the E/M service is not included in the time used for reporting the psychotherapy service. Time may not be used as the basis of E/M code selection and prolonged services may not be reported when psychotherapy with E/M (90833, 90836, 90838) are reported.
I understand that means that if an office visit or inpatient encounter is also performed with psychotherapy, the E/M level must be selected based on medical decision making. My question is what if a hospital discharge is performed with psychotherapy? The 2 codes 99238 and 99239 are based solely on time, MDM is not an option. 99238 and 99239 are both valid primary procedures for the add-on psychotherapy codes. How could 99238 vs 99239 be determined without the use of time? The guidelines state time may not be used as a the basis of E/M code selection when psychotherapy with E/M is reported, so how would 99239 be able to be reported with psychotherapy?