30 hours of clinical work per week?

[AbnormalPsych]

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Pffft. RVUs are great. You just see someone for 55 minutes of psychotherapy, tell them to not smoke, bill 95618 , 95619 (x2), and 99406, then do an hour of record reviews and learning about the medical illness with 99358, maybe call up the physician and use 99240 while reading. Do that three times per day, and that’s ~3500 RVUs year. That’s a pretty easy life.

Tried to look a bunch of these up. Aside from 99406/99407 I can't seem to find them. What am I doing wrong?

 

[PsyDr]

1) listening to me is probably the first mistake. I try to ignore myself.

2) I mistypes 96518 = H&b code for 30 min, 96519 is every additional 15 min, iirc. Those pay more than typical psych codes, but you have to be medically focused.

3) 99358= non face to face time for case management. Not sure if psychologists can use that, but surely that doesn’t apply in the VA, right? But I dunno how VA billing works. Seems silly to employ someone with a pool of money, and then act as if that employee is billing from that same pool of money. I would NOT consider this in normal settings.

4) 99240 was another mistype. I think it’s 99241- 992whatever = case consult codes with another provider without the patient present, I think. No idea if psychology can use 99 series, but if it’s the VA, it’s silly anyway. I would NOT consider this in normal settings.

 

[tr]

Can you really do exposure or CBT, if the patient only wants to be satisfied?

I've had a few of this type of patients who came around to active therapy.

I always set up the expectation that we will have a defined goal for at work and once we reach that goal, will plan to terminate therapy. I've had a couple patients who said they didn't want to work that way but only wanted supportive. (Personality disorders seemed to be the common denominator.)

I said that wasn't my forte but we could try it for a little while. After a period of time in which every time they complained about something I said, "That sounds awful ... And is it something you would like to work on changing at all?" eventually they all came around to establishing a therapy goal and agreeing to do some kind of reasonably constructive homework.

I don't work in the VA system with its perverse financial incentives for maintaining the sick role though. That seems like it would be insoluble other than by overhauling the service connection system.

 

[deleted1129370]

I max out at 20 clinical hours per week. Needless to say, I don't hit my RVUs, and I don't care. I'm not exactly concerned about not getting the Red Lobster gift card for hitting my performance goal.

 

[Sanman]

I max out at 20 clinical hours per week. Needless to say, I don't hit my RVUs, and I don't care. I'm not exactly concerned about not getting the Red Lobster gift card for hitting my performance goal.

Fine, but you are missing out on some amazing biscuits.

 

[WisNeuro]

Fine, but you are missing out on some amazing biscuits.

They sell that **** in a box at the grocery store. Same recipe and everything.

 

[Sanman]

They sell that **** in a box at the grocery store. Same recipe and everything.

I know, but is does not come out quite the same if you follow the instructions.

 

[WisNeuro]

I know, but is does not come out quite the same if you follow the instructions.

 

[borne_before]

They sell that **** in a box at the grocery store. Same recipe and everything.

I know, but is does not come out quite the same if you follow the instructions.

Do you guys want to know the secret to good biscuits?

 

[Sanman]

Do you guys want to know the secret to good biscuits?

Well, don't keep us in suspense. I always assume it is extra butter.

 

[Sanman]

I'm sorry no. Red Lobster used to be a special treat growing up. Don't ruin Cheddar Bay biscuits and virgin strawberry daiquiris for me.

 

[Dazen]

Do you guys want to know the secret to good biscuits?

Please don't say lard...

 

[WisNeuro]

I'm sorry no. Red Lobster used to be a special treat growing up. Don't ruin Cheddar Bay biscuits and virgin strawberry daiquiris for me.

No judgment here. Red Lobster is the epitome of Red Neck luxury 😉

 

[borne_before]

Well, don't keep us in suspense. I always assume it is extra butter.

This applies to a lot of baking, from corn bread to biscuits, but people tend to over knead them doughs that don't need gluten development. Gluten makes things rubbery and tough. Good for pizza, bad for things you want tender.

You really just want to combine the ingredients into a messy shaggy mess. Don't even worry about hydrating all the flower or getting all the lumps out. Alton Brown suggests folding his biscuit dough like four times, only using a dough scraper to contact the dough.

tldr: You're prolly just over mixing the mix.

 

[Sanman]

No judgment here. Red Lobster is the epitome of Red Neck luxury 😉

Different luxuries for my family now...how far we have come.

 

[WisNeuro]

View attachment 373968

Different luxuries for my family now...how far we have come.

I'm with you. We also grew up with very little and from a southern background.

 

[tr]

View attachment 373968

Different luxuries for my family now...how far we have come.

Is it weird that my first thought about this picture was, "I bet there's a bunch of alligators under there"?

 

[Sanman]

Is it weird that my first thought about this picture was, "I bet there's a bunch of alligators under there"?

No gators in these waters. May see a shark or two further out.

 

[cara susanna]

I'm sorry no. Red Lobster used to be a special treat growing up. Don't ruin Cheddar Bay biscuits and virgin strawberry daiquiris for me.

I grew up in a place where you ALWAYS eat fish on Fridays, and I hated seafood. Red Lobster was the one place that had good non-seafood options.