Psychotherapy performed same-day as E/M service by clinician

rhotonscott

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I've worked as a Psych Coder for a Community Mental Health Center for a numver of years. We have both prescribers doing medication management and clinicians doing therapy. Often our clients have both their prescriber (E/M) visit and their clinical (psychotherapy) visit same-day. It makes sense clinically as getting clients with severe mental illness to come into the office is difficult enough, so doing both visits same-day helps with treatment. Problem is, NCCI edits do not allow this unless the psychotherapy is done as add-on code to the E/M visit-I have written and spoke to many learned folks on this subject, and the concensus is that only the prescriber or other prescribers can use the add-on code with the E/M visit.
Per CPT: 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. These services are reported by using codes specific for psychotherapy when performed with evaluation and management services (90833, 90836, 90838) as add-on codes to the evaluation and management service.
Question: Do clinicians (therapists) qualify as "other qualified health care professional" and can I use add-on code (90833,90836, 90838) when they do same-day therapy as E/M service (99212-99215). The assumption is that it is within the scope of their practice and they are credentialed for the the insurer billed
 

cfordCPC

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An E/M (99202-99215) with a psychotherapy add-on code (90833, 90836 & 90838) can only be assigned by providers who are qualified to perform evaluation and management services. A clinician (therapist) in this instance would not be considered a "...other qualified health care professional" as they cannot perform E/M services; this is outside of their scope of practice. Also, both components of the service would be performed in the same session by the same provider and not be performed separately by more than one provider.
 

sumithratc

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For Psychiatrist, we can use enm codes along with add-on 90833,90836,90838 for that visit and for psychologist, we can code 90837,34,32. I think
 

TThivierge

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Hi
Yes you can bill both together but the catch is are the providers discussing(documenting) the ongoing chronic medical illness and the BH services on the treatment for the day?. Then you would link the proper CPT with differ dx reviewed. As an example : the patient has ongoing back aches dx M54 and DM E11.9 but get treated also for Depression F32 and Sleep Apnea dx. G47.30 .Minutes/time should be given for mental and medical illness documented in the record what is discussed and meds for each problem. Then link dx F32 and G47 with the beh. health CPTs and the eval & mgnt CPT with dx M54 and DM E11.9. the Psychiatrist, NP, PA can bill anything but the LSCW should stick with the beh health codes.
I hope this data helps you.
Lady T
 
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