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Thread: Billing for Depression

  1. #1

    Default Billing for Depression

    AAPC: Back to School
    Our primary care physician's office treats a lot of depression. Medicare has recently begin applying a psychiatric reduction to our claims. We file E/M 99213 most of the time. I am curious how other PC offices bill depression. I am fairly new to coding so I would appreciate any information.

    Thank you

  2. #2
    Join Date
    Apr 2007
    Seacoast- Dover New Hampshire


    Because of the dx code in the primary position.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  3. #3
    Join Date
    Apr 2007
    Lincoln, NE


    I bill anesthesia for ECT (electroconvulsive therapy) services. Whenever the service is outpatient (POS 22) Medicare applies the 50% mental health reduction. When inpatient (21) this reduction is not applied. I didn't know that this reduction was also applied to office visits with a mental health dx- good to know - so it's not just the diagnosis but also the place of service that drives the reduction. It has been my experience that, on assigned claims, MOST supplemental insurance carriers pay the full balance remaining after Medicare payment.

    Hope this helps.

    Julie, CPC

  4. #4


    Thank you - very helpful

  5. #5
    Join Date
    Apr 2007
    Baton Rouge Local Chapter


    I've always seen this reduction take place if the depression or anxiety diagnosis is listed as the primary diagnosis.

  6. #6
    Join Date
    Apr 2007
    Pensacola, FL


    We get down coded as well and it's really frustrating. I also noticed on one of my last EOB's that we were down coded for a headache....

    Kristie Stokes, CPC, AIHC ICDCT-CM

    AAPCCA Board of Directors 2014-2017
    Region 1 - Northeast
    Maine, New Hampshire, Vermont, Massachusetts, Connecticut, Rhode Island, New York

    Today, give a stranger one of your smiles. It might be the only sunshine they see all day.

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