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Psych codes vs E/M codes

  1. #1
    Default Psych codes vs E/M codes
    Medical Coding Books
    A question was brought up in our clinic about billing with E/M codes instead of using psych codes. To me I am under the understanding as a coder that ethically we need to be using psych codes where approproiate. We are looking at taking on another MD from a different state who said their clinic uses E/M codes instead of psych codes? Does anyone else do this? Is this something that we can do? I am looking for any help you can give or any coding workshops for MH. Please let me know. I am on a time crunch to weigh the pros and cons of each and need as much help as I can get. Thank you all

  2. #2
    The providers need to bill the most appropriate code to the service they perform. If they are doing therapy, they need to bill therapy codes. If they are doing med mgmt, they need to bill that code. If they are documenting their services appropriately, there should not be a reason to have to use the EM codes very often. We did use them for a little while because we thought that was the best route, but it was a PITA!! We received a lot of denials because of psych dx with medical code, claims going to medical insurance rather than the pt's mental health plan, a lot would deny because of the providers specialty ( basically they wanted to see psych codes)

    We were using EM's for a provider who was basically doing med mgt, but we used it because she wasn't necessarily making major med changes.. after learning more, we decided we could still accurately use 90862 and went back to that.

    What is their reason behind wanting to bill EM codes vs psych?

  3. #3
    Louisville, KY
    The basic determinant is not choice, so much as the purpose of the services.

    If medication management is key, then 90862 is appropriate--as example. Also, the three (3) key components (or for established patients, at least two [2]) must be met in order to code for an E/M service.

    In the event your providers are performing psychotherapy, those are coded to that section (90804-90829). I would certainly hesitate from varying from the prescribed codes. Although I have no "objective" source, I'd certainly expect an external audit to question deviations from the norm. If I were the auditor, I would certainly question that practice.

  4. #4
    we have always used the psych codes for the services unless we could not bill a psych code then we would on occasion use an E/M code. We are looking at all of our options. Does anyone know if payers usually reemburse lower with MH Dx on and E/M code? I think they usualy pay about 50% of what they would have allowed?? but I am not sure on that either.

  5. #5
    I never heard of payers reimbursing at a lower rate when using a psych Dx with E/M. We haven't seen any denials or lower reimbursements.

    We primarly see inpatients. We use psych codes and E/M based on which is most appropriate for the service. I agree with the above responses...i.e. if doing psychotherapy use psychotherapy codes, if doing med mgmt 90862, etc. We use the subsequent hospital E/M codes when the Dr is not doing psychotherapy/med mgmt. We also use the consult codes because we provide a consult service.

    If the visit is more than 50% counseling/coordination of care you can choose your E/M based on time (please review the CPT guidelines for more info on choosing the appropriate level).
    Donna E. Young, CPC

  6. #6
    I agree with Deyoung..we use EM's as well inpatient ie 99231-3 and 99251-5

  7. #7
    thank you all for your great feedback. this made me feel more confident in how I have been billing these services. MH is something that there really isn't a lot of training in. If anyone knows of any MH billing or coding courses please let me know.

  8. #8
    There is not much out there for seminars. I went to one, and it wasn't even all that helpful.

    Of all the resources I have found, this board actaully seems to be one of the best places I have gotten answers from, so for now, I would encourage you to keep posting here!

  9. #9
    Dover Seacoast New Hampshire
    The E&M codes would never be appropriate for non-physician providers (excluding medical nurse practitioners). With Masters' level clinicians, LICSWs, Ph.Ds and Psy.Ds, you must stick to the mental health codes in the Medicine section of CPT, depending on scope of practice. Psychiatrists can use E&M only if medically necessary, but the nature of the presenting problem and the intent of the visit should drive the CPT code. Pam Brooks, PCS, CPC

  10. #10
    Default Questions remain
    I am relatively new to our practice and the providers in our geriatrics center are entrenched in using E&M codes. We are not having problems with reimbursement but I am concerned about their documentation. They say they were cleared by compliance years ago, but I am still requesting that compliance audit a few charts so I can be assured that they are billing for the services they are providing-now.

    I am planning to attend an inexpensive Coding and Billing for Mental Health Services conference in May. Check out their website to see if you are interested: they have 4 sites in Tenn, Alabama and Atlanta.

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