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2 apts, same tax ID, 2 different disciplines

  1. #1
    Default 2 apts, same tax ID, 2 different disciplines
    Medical Coding Books
    Is there any hope of us getting paid for both appts if a patient sees a psychologist and a psychiatrist on same day, same clinic, same tax id, but 2 different disciplines? Where can I find something in writing on this? One apt for med mgmt and one for therapy

  2. #2
    Default you can try
    if you can prove that the provider is specialized in a certain area distinct from the other, you can appeal it and have a decent chance at getting paid.

    i have this same issue when a cardiologist and an electrophysiologist (same practice, same tax id) see a patient on the same day. the cardiologist is strictly non-interventional ... the electrophysiologist is an area of expertise, a branch of cardiology ... though they are both considered "cardiologists"

    i have been very successful on an appeal basis. (even medicare) it's not therapy or medication management but same concept. good luck!!

  3. #3
    Madison Area Chapter in Madison WI
    There seems to be some confusion between the clinical and coding definitions of "med management". From a coding perspective "med management" is done by the MD (psychiatrist) and the correct code is 90862. (90862 Pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy) This involves minimal therapy and is not a time base code.

    However, many clinical practices view "med management" as a “15 minute appt” and code it as one of the psychotherapy with E/M codes. (e.g. 90805, 90807, 90809 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility… with medical evaluation and management services)

    In my experience working with both the clinical and coding perspectives, I've found this situation is usually a psychotherapy session with the psychologist and med management (90862) by the psychiatrist. If this is the situation, both services are billable according to the NCCI.

    If both psychotherapy and psychotherapy with E/M are providing, they are not separately billable. From a coding perspective, the psychotherapy session is a component of the psychotherapy w/ E/M session. From a clinical perspective, there is a medical necessity concern. However, there are times, when the services may be medical necessary. I would suggest a call to the payer to explain the medical necessity and good documentation should help. I hope this is helpful.
    Happy Coding, Claudia

    Claudia Yoakum-Watson, CPC
    Coding, Compliance, & Reimbursement Solutions
    [email] - website

  4. #4
    We just recently had this happen to us, but this link might help if you go to page 5 its from WPS
    "Physicians in the same group practice but who are in different specialties may bill and be paid without regard to their membership in the same group."

  5. #5
    North Carolina
    C. Psychiatric Services
    CPT codes for psychiatric services include general and special diagnostic services as well as a variety of therapeutic services. By CPT Manual definition, therapeutic services (e.g., HCPCS/CPT codes 90804-90829) include psychotherapy and continuing medical diagnostic evaluation; therefore, CPT codes 90801 and 90802 are not reported with these services.Interactive services (diagnostic or therapeutic) are distinct forms of services for patients who have "lost, or have not yet developed either the expressive language communication skills to explain his/her symptoms and response to treatment...". Accordingly, non-interactive services would not be possible at the same session as interactive services and are not to be reported together with interactive services.
    Drug management is included in some therapeutic services (e.g., HCPCS/CPT codes 90801-90829, 90845, 90847-90853, 90865-90870) and therefore CPT code 90862 (pharmacologic management) is not to be reported with these codes.When medical services, other than psychiatric services, are provided in addition to psychiatric services, separate evaluation and management codes cannot be reported. The psychiatric service includes the evaluation and management services provided according to CMS policy.
    Last edited by RebeccaWoodward*; 03-06-2009 at 01:43 PM.

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