Time Documentation for 99213 with 90833

shellysk8

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I have run across this issue on 2 notes by the same provider (psychiatrist, MD) during an audit. He begins by stating, "Patient xxx here for 30 minute visit for psychotherapy and medical management". He then documents a beautiful note, clearly delineating a portion for the medical portion and the therapy portion. In auditing the medical portion, it does qualify on its own as a 99213. My concern is if the visit is truly only 30 minutes, can he bill for both services? Some sources I have read indicate that the 90833 can be billed for 16-37 minutes of therapy, and CPT definition of 99213 SUGGESTS an average time of 15 minutes. Ideally, the visit would be 45 minutes to alleviate this. I will be working with him on this portion of documentation, but I cannot find any concrete guidance to help with my current question. Any suggestions?

Thanks in advance!
Shelly
 

jdyoutsey

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The E/M time guideline is just an average and not an absolute. What you really need to be looking for in the delineation between medical service and psychotherapy is the time spent on psychotherapy. The psychotherapy codes are driven by time and time alone, so the provider needs to have documented the time spent on just psychotherapy to bill the 9083x.
 

shellysk8

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99213 and 90833

The E/M time guideline is just an average and not an absolute. What you really need to be looking for in the delineation between medical service and psychotherapy is the time spent on psychotherapy. The psychotherapy codes are driven by time and time alone, so the provider needs to have documented the time spent on just psychotherapy to bill the 9083x.

Thanks for the quick answer! So, since his note indicates "30 minute appointment for psychotherapy and medical management", and doesn't spell out the time spent in psychotherapy specifically, the 90833 isn't billable? I've been leaning this way but the rest of the note has very good documentation and delineation.
 

jdyoutsey

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Thanks for the quick answer! So, since his note indicates "30 minute appointment for psychotherapy and medical management", and doesn't spell out the time spent in psychotherapy specifically, the 90833 isn't billable? I've been leaning this way but the rest of the note has very good documentation and delineation.

I would say that if that is the way it is documented the 90833 isn't billable. Here is a section from MLN Matters SE1407: "Because time is indicated in the code descriptor for the psychotherapy CPT codes, it is important for providers to clearly document in the patient’s medical record the time spent providing the psychotherapy service rather than entering one time period including the E&M service."

View attachment SE1407.pdf
 
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