Wiki psychotherapy and E/m, same visit

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erjones147

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Relatively new to coding and definitely new to MH coding, so I thought I'd get some feedback....

New psychiatrist going to start working for our clinic next month. During a meet-and-greet phone call, this psychiatrist swears that he always bills an E/M code AND a psychotherapy code and gets paid for it, even though he does not do a history or an exam.

He claims that there were sweeping new changes last January that allow him to do that. I have not heard of any such changes to the CPT psych codes, and I most definitely have not heard of any changes to E/M requirements that would allow him to do that.

Am I missing something?
 
erjones147 said:
Relatively new to coding and definitely new to MH coding, so I thought I'd get some feedback....

New psychiatrist going to start working for our clinic next month. During a meet-and-greet phone call, this psychiatrist swears that he always bills an E/M code AND a psychotherapy code and gets paid for it, even though he does not do a history or an exam.

He claims that there were sweeping new changes last January that allow him to do that. I have not heard of any such changes to the CPT psych codes, and I most definitely have not heard of any changes to E/M requirements that would allow him to do that.

Am I missing something?
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the E/M requirements have not changed. it still requires 2/3 H&P, Exam, MDM to be a valid established client visit E/M visit, or requires 50% time be spent on counseling/care coordination. (but remember that the level of the E/M code itself requires different amounts of these things, so if it is only a 99211-99212 it would be very straightforward)

you can bill an E/M visit with an add on code for therapy, but it is imperative to note that the time spent on E/M does not overlap with time spent in therapy, and at least 16 minutes is required to be a valid therapy code. it is possible to bill E/M with therapy, but the guidelines for both codes must be met.

It may be worth auditing a few of his visits up front to make sure that the guidelines are being met.
 
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