How common is psychs doing 90807 over the phone

[markcinnn]

Saw a psych several years ago in undergrad. Initial eval and he gave me a prescription after 1st session. Never saw him again. He did call me 2 days later and asked me how the prescription was going. As I recall I we spoke for less than 5 minutes.

Recently a collections agency finally tracked me down with a big bill. I used insurance so was surprised. Got verification for bill and according to it he didn't use my insurance (have to ask my parents to contact their insurance co to find out if true) and billed me for a second session too (90807) for the phone call. Academic psych with a pp on the side.

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[DD214_DOC]

Saw a psych several years ago in undergrad. Initial eval and he gave me a prescription after 1st session. Never saw him again. He did call me 2 days later and asked me how the prescription was going. As I recall I we spoke for less than 5 minutes.

Recently a collections agency finally tracked me down with a big bill. I used insurance so was surprised. Got verification for bill and according to it he didn't use my insurance (have to ask my parents to contact their insurance co to find out if true) and billed me for a second session too (90807) for the phone call. Academic psych with a pp on the side.

90807 is an older CPT that I'm not very familiar with. It's an old Psychotherapy w E/M code and is time-based, 45-50 minutes, and requires BOTH a medication management component and psychotherapy component. So, unless my reference was wrong, he's trying to swindle you and is probably why insurance wasn't billed. There are also specific documentation requirements for 90807, so either the note does not meet the criteria for the code or the encounter note is complete BS.

 

[Dr. In Formation]

Saw a psych several years ago in undergrad. Initial eval and he gave me a prescription after 1st session. Never saw him again. He did call me 2 days later and asked me how the prescription was going.

So brave of you to admit you suffer from mental illness. I know how stigmatizing that is in our society, especially among medical professionals.

I applaud you and hope you are still in treatment.

 

[666357]

I use 99441-443. 90+% are 99441. These are all for calls that I receive on my emergency line. I can usually take care of the matter in few minutes. They're never outgoing calls. If I need to f/u on a pt (SI, psychosis, etc), I typically have my staff make the call.
Anyway, there are additional criteria to bill these codes (cannot see them in clinic within so many days of the emergency call, etc). If a carrier doesn't reimburse those codes, then the pt is responsible for the full amount. No matter what specialty of medicine, there's a code for every bit of clinical work you do- most clinicians simply underbill though the provider referenced by the OP appears to be clueless or is ripping the OP off.

 

[666357]

It is my understanding, that unless you have a formal telepsych practice set up, and you are in one of the few states that recognize telepsych and allow you to bill for it with private and/or public insurance, that you cannot bill insurance for phone calls.

These codes aren't for telepsych- they're specifically for brief E&M over the phone. CMS won't reimburse and there's a mix of reimbursement by carriers (some of my BCBS plans will pay). "Cannot bill" doesn't register. You (should) always bill for any and all valid and legitimate service rendered for which there's a code. You can submit bills all day long but what's reimbursed per your fee schedule is a different story and unpaid balances are the responsibility of the patient. You do need to state that such codes might not be reimbursed and that the pt will be responsible for any such balances on your new patient agreement form.

• 99441 Telephone evaluation and management (E&M) service provided by a physician to an established patient, parent, or guardian not originating from a related E&M service provided within the previous seven days nor leading to an E&M service or procedure within the next 24 hours or soonest available appointment; five to 10 minutes of medical discussion
• 99442 11 to 20 minutes of medical discussion
• 99443 21 to 30 minutes of medical discussion

 

[thoffen]

These codes aren't for telepsych- they're specifically for brief E&M over the phone. CMS won't reimburse and there's a mix of reimbursement by carriers (some of my BCBS plans will pay). "Cannot bill" doesn't register. You (should) always bill for any and all valid and legitimate service rendered for which there's a code. You can submit bills all day long but what's reimbursed per your fee schedule is a different story and unpaid balances are the responsibility of the patient. You do need to state that such codes might not be reimbursed and that the pt will be responsible for any such balances on your new patient agreement form.

I wouldn't feel comfortable with such a thing unless I was confident the patient understood that I was providing a service that would be billed and some idea of the possible cost to them.

 

[666357]

I wouldn't feel comfortable with such a thing unless I was confident the patient understood that I was providing a service that would be billed and some idea of the possible cost to them.

Of course- that's why you ensure they've received a copy of your fee schedule and list of services when you establish the therapeutic relationship. There's nothing shady about it. You're just saying, "I don't work for free" and here's what my services cost, and they may or may not be covered by your insurance. I can tell you that there's no code for filling out forms or writing letters, but I have fees for those as well. Never had a complaint thus far- knock on wood.