As I understand it, you document based on MDM qualifications. In other words, you must reach the correct MDM as 1 of the 3 required.
Psychotherapy add ons should only be for specific time utilized for therapy - not documenting or med management. It would thus be impossible for a 30 min visit for a therapy add on. You would use a specific psychotherapy only code.
I'm new to this as well, so I apologize if I get anything wrong. Based on a PowerPoint and reading the 1997 E&M rules, this is what I've gathered.
Wrong...
This is obviously arcane stuff (thanks gov't!) so make sure to get some good background from a professional coder before you go out into practice... I'm amazed at how much I've had to learn in only 1 months, and grateful that I'm at a larger organization and not solo right now. If you're solo or don't have that kind of support, go to psych.org ASAP and do all their learning activities on it. They even have some coded notes for you to look to as examples, and templates and stuff.
1) For "new patient E&M" (99201-5)--WHICH YOU WILL PROBABLY NEVER USE--all 3 elements are required--i.e., the "lowest of the 3". So the MDM needs to be there.
For established E&M (99211-5), it's 2/3--and can be any combination, per my coders. Some of the charts of mine they audited this week as we went live reached it by History + Physical, some reached by Physical + MDM.
I say you'll never use the 99201-5 because psychiatrists have 99791-2 at our disposal, which in RVU terms (2.8 and 2.92) is greater than a Level 4 new E&M, only slightly less than level 5, and has significantly less acuity requirements / documentation requirements / billing restrictions (the 3 year practice rule for instance).
2) In a truly bizarre move, you only have to do 16 minutes of psychotherapy to bill for 30 minutes. It's called the "50% rule". They wanted clear guidelines as to what number of minutes counted for which level, for the "in betweens". So you know whether to round up or down. I don't have the exact numbers in front of me but it's like 16-37 mins bill 30 mins, 38-52 bill 45, 53+ bill 60. So yes you can bill an E&M code plus a 30 min psychotherapy code for a 30 minute visit, provided you actually did and then subsequently document that 16+ minutes of it was psychotherapy, and met the appropriate E&M level for what you coded. Totally goofy.
Hope this helps. Folks in my group are ranging from nonplussed to totally freaking right now.
