Wiki Psychotherapy & E/M on same date, different providers

[betsycpcp]

I work for a payer and we are seeing bills from a psychiatrist's office where he or a CNP will see the patient for medication management and bill an E/M code (usually 99213), and on the same date a licensed professional counselor in their office will do therapy and bill 90832. I know that if the psychiatrist or CNP did both services, they would bill 99213 plus an add-on code such as 90833. By billing under two separate providers and using the non add-on code 90833, they're being paid about $30 more per date. Is this appropriate? I can't find any specific guidelines.

Thanks for any help.

 

[cjhalk@yahoo.com]

I would say this not ok. From the CPT book:
"Some psychiatric patients receive a medical evaluation and management (E&M) service on the same day as a psychotherapy service by the same physician or other qualified health care professional. To report both E&M and psychotherapy, the two services must be significant and separately identifiable."
It also states in the same paragraph, these services are reported by using codes specific for psychotherapy when performed with E&M AS ADD ON CODES TO THE E&M.
For me, the description makes a distinction between "same physician or other health care professional-" but does not say that the distinction warrants a separate E&M code and a separate 90832, 34, or 37. It actually says to code them together.
Anyway, that?s my thoughts on it.

 

[betsycpcp]

I kind of see it the same way, but it's one of those things that it would be nice to have explicit guidance for. It definitely doesn't feel right. Thanks for your reply--it helps if someone else has the same interpretation.

 

[deyoung]

I agree. If they are billing under the same TIN, they are considered one so they should be combining the services & using the add-on code. You may be able to dig around & find something in writting on the CMS site.