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Psychiatric E/M for deaf client

  1. #1
    Default Psychiatric E/M for deaf client
    Medical Coding Books
    So, when a client who is congenitally deaf who comes in for her quarterly med check we have a little confusion as far as coding. After reviewing all of the documentation from my psychiatrist, this definitely meets the 1997 documentation guidelines for 99214, but at the end the MD noted that face to face time with client is 60 minutes and also noted this due to the client's deafness, ASL was needed, therefore prolonging the visit to 99215.

    So my question is, given that the face to face time is noted as 60 minutes, would it be appropriate to code 99215 even though the rest of the documentation for E/M only supports 99214 other than face to face time with client?

    Also, I know that because it was only 60 minutes face to face, 99354 (prolonged services) would be inappropriate; however, would a modifier 22 for increased services be appropriate? Also note, this is a Medicare client.

    Any feedback is greatly appreciated, thank you~

  2. #2
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    I would bill 99214. In order to bill a 99215 based on time, over half of the time spent must be in counseling and coordinating care, which it does not sound like it was. It simply took longer because he is deaf. I would not use 22 mod either.

  3. #3
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    What about using the interactive codes with E&M services ?

  4. #4
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    I'd have to agree with smdumpert. The Interactive Psychotherapy Codes with E&M services may be more appropriate. The use of an interpreter of any kind does qualify the service as an "interactive" therapy service.
    Chandra L. Stephenson, CPC, CIC, COC, CPB, CPCO, CPMA, CPPM, CRC, CCS, CPC-I, CANPC, CCC, CEMC, CGSC, CFPC, CIMC, COSC
    2012-2013, 2016 President, AAPC Indianapolis Indiana Chapter
    2013-2015 AAPC National Advisory Board Member
    chandra.stephenson@gmail.com

  5. #5
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    Quote Originally Posted by clsteph1 View Post
    I'd have to agree with smdumpert. The Interactive Psychotherapy Codes with E&M services may be more appropriate. The use of an interpreter of any kind does qualify the service as an "interactive" therapy service.
    That would only be appropriate if this dr is actually performing therapy. There are some- alot actually- that do not do therapy.

    The op's notes say a med check and that would not qualify as therapy

  6. #6
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    Quote Originally Posted by 1073358 View Post
    That would only be appropriate if this dr is actually performing therapy. There are some- alot actually- that do not do therapy.

    The op's notes say a med check and that would not qualify as therapy
    yes, unfortunately, this was not an interactive therapy visit, client was in office for her medication check only. Visit was very extensive due to the need for ASL, and client needed several clarifications on her medication changes. We ended up leaving this as a regular 99214.

    Thank you all so much for your feedback I really appreciate it
    Jessica

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