- Joined
- Feb 24, 2010
- Messages
- 3,226
- Reaction score
- 6,536
I'm curious if any FM have billed the therapy add on code 90833 to the usual E&M 9921(3-5)? Has insurance reimbursed you for it?
I'm curious if any FM have billed the therapy add on code 90833 to the usual E&M 9921(3-5)? Has insurance reimbursed you for it?
No this question wouldn't be more appropriate for psych. With intention, I posted it here for the real world experience of FM. I am specifically trying to ascertain if non-Psychiatry based taxonomic physicians have attempted to bill and been successful with this add on code. An FM could drop this code for numerous reasons.No, since we don't tend to do therapy.
Wouldn't this question be better suited to the Psychiatry forum?
It makes perfect sense when you realize that Psychiatrists aren't the only ones doing therapy. Just tacking it on is sloppy, and likely rife with billing fraud. Pointedly adding it on, and documenting the necessary metrics is something that not every visit meets. I've seen enough collateral records cross my eyes to know that simply checking 90833 or dropping the code on a billing sheet is insufficient.this doesn't make any sense. Im a psych, and this is something(when I did outpt) I would just tack on for every med mgt visit to make the compensation more appropriate. But I don't see how a non-psych could do it. it is used just for psych.
This would be like me trying to throw in a code for an I and D, I'm a psych; what the hell do I know about an I and D? (even if I did one during the visit.....and if I did do well, why the hell did I do one?)
Thanks for that. Seems a bit dated with the ICD-9 and DSM-IV-TR tossed in there. I did note the comment about advising against PCPs from billing psych codes but it didn't necessarily say why.Most FPs just use time-based billing for that stuff. I've been told therapy codes won't be reimbursed unless you're psych.
Thanks for that. Seems a bit dated with the ICD-9 and DSM-IV-TR tossed in there. I did note the comment about advising against PCPs from billing psych codes but it didn't necessarily say why.
I could understand perhaps a psych new eval code 90872, but I'm still not buying why an FM couldn't appropriately document and submit for 90833 add on.
Thanks for that. Seems a bit dated with the ICD-9 and DSM-IV-TR tossed in there. I did note the comment about advising against PCPs from billing psych codes but it didn't necessarily say why.
I could understand perhaps a psych new eval code 90872, but I'm still not buying why an FM couldn't appropriately document and submit for 90833 add on.
It makes perfect sense when you realize that Psychiatrists aren't the only ones doing therapy. Just tacking it on is sloppy, and likely rife with billing fraud. Pointedly adding it on, and documenting the necessary metrics is something that not every visit meets. I've seen enough collateral records cross my eyes to know that simply checking 90833 or dropping the code on a billing sheet is insufficient.
It is an E&M code, and thus far I have not read anything that clearly states it is only for Psych. My understanding is any E&M code is billable by any physician, but it is the insurance contracts that dictate the compensation. So my question again, have any FM billed for this and been paid?
Thanks for that. Seems a bit dated with the ICD-9 and DSM-IV-TR tossed in there. I did note the comment about advising against PCPs from billing psych codes but it didn't necessarily say why.
I thought you were a psychiatrist?Thanks for that. Seems a bit dated with the ICD-9 and DSM-IV-TR tossed in there. I did note the comment about advising against PCPs from billing psych codes but it didn't necessarily say why.
I could understand perhaps a psych new eval code 90872, but I'm still not buying why an FM couldn't appropriately document and submit for 90833 add on.
Yes it would because non-psych physicians almost never do therapy.No this question wouldn't be more appropriate for psych. With intention, I posted it here for the real world experience of FM. I am specifically trying to ascertain if non-Psychiatry based taxonomic physicians have attempted to bill and been successful with this add on code. An FM could drop this code for numerous reasons.
Yes, Since 4/1/2020 I billed for it 26 times and on average it pays me ~$66. This is in addition to my 99214 code.I'm curious if any FM have billed the therapy add on code 90833 to the usual E&M 9921(3-5)? Has insurance reimbursed you for it?
Investing Doc, thank you. Thank you for a quality response and positive addition to what the purpose of this thread is.Yes, Since 4/1/2020 I billed for it 26 times and on average it pays me ~$66. This is in addition to my 99214 code.
I only bill for it when I talk to patients about non pharm ways extensively to help with their psych symptoms. I have a pretty big focus on mental health and see a lot of anxiety and depression in my office. I'm by no means an expert (psychologist) but love to talk about mindfulness and even did some exposure based therapy where someone was deathly afraid of stairs and we built up to taking the stairs down to the ground level to get a coffee.
The basics for CBT for anxiety are not that hard to talk about. Deep breathing, “I've done this before, just take deep breaths" etc.
I document like crazy what I talked about CBT wise and even if I get audited I've never had a claim reversed.
Why? So you get paid for the work and services you perform. That is why enough.
That's why not. It is quite rare for PCPs to do any psychiatric therapy. I'm sure there are some who do (like the above poster) but I would guess that probably 95+% of us don't.Why? So you get paid for the work and services you perform. That is why enough.
The very first post was for those who have. You have made it very clear you don't and won't.That's why not. It is quite rare for PCPs to do any psychiatric therapy. I'm sure there are some who do (like the above poster) but I would guess that probably 95+% of us don't.
Its the same reason I don't bill for extended ophthalmoscopy (which is also an add-on code to E&M) - because I don't do it.
Investing Doc, thank you. Thank you for a quality response and positive addition to what the purpose of this thread is.
By chance is this broad spectrum insurance or was this more focused on one or two insurance? I'm trying to gauge if any patterns can be noted from your limited sample.
Contrary to some of the earlier Nay Sayers, I commend you and support your application of this add on code. And for Vistaril's sake, I say this as a Psychiatrist...
Why? So you get paid for the work and services you perform. That is why enough.
Thank you again.Seems like all across the board have paid but some of course went towards high deductible plans and those patients have not paid me yet.
90833 requires 16 minutes. FM can finish a 99214 visit and note in 12 minutes or less, and move on to the next COPD, DM, CHF, HTN patient.
Yes, Since 4/1/2020 I billed for it 26 times and on average it pays me ~$66. This is in addition to my 99214 code.
I only bill for it when I talk to patients about non pharm ways extensively to help with their psych symptoms. I have a pretty big focus on mental health and see a lot of anxiety and depression in my office. I'm by no means an expert (psychologist) but love to talk about mindfulness and even did some exposure based therapy where someone was deathly afraid of stairs and we built up to taking the stairs down to the ground level to get a coffee.
The basics for CBT for anxiety are not that hard to talk about. Deep breathing, “I've done this before, just take deep breaths" etc.
I document like crazy what I talked about CBT wise and even if I get audited I've never had a claim reversed.
There are CME courses.
There are apps patients can use.
There are books.
Strike up some conversations at CME conferences, you'll realize not all at the APA are Psychiatrists.
And more importantly, we don't even have the proper foundation to learn how to do therapy.I guess....but the same could be said for pretty much anything.
I mean I can watch a video on someone draining an abcess. I don't think that means I should then go out and do it and code for it. After all, I've never had any training in that after med school.
I don't think the family medicine docs want us draining abcesses, and I think most psychs wouldn't be keen on most family medicine docs providing therapy based on some books they read or an app or youtube or whatever.
That's why not. It is quite rare for PCPs to do any psychiatric therapy. I'm sure there are some who do (like the above poster) but I would guess that probably 95+% of us don't.
Its the same reason I don't bill for extended ophthalmoscopy (which is also an add-on code to E&M) - because I don't do it.
90833 requires 16 minutes. FM can finish a 99214 visit and note in 12 minutes or less, and move on to the next COPD, DM, CHF, HTN patient.
And more importantly, we don't even have the proper foundation to learn how to do therapy.
I've done procedures and managed conditions I didn't learn in residency but I had the background to build on so it didn't require a whole new skill set.
I think more FM docs practice methods of psychotherapy than you imply, but I do doubt many really hit the time component necessary with that. Brief interventions and abridged MI abound in primary care, but they are not lengthy due to the nature of the primary care visit.
Yup, exactly.
I think this really depends on the individual. You have RNs, BS in Psych, NPs, and obviously plenty of LISWs doing therapy. Many people have worked in the area prior to med school, have other advanced degrees, or just have a sufficient enough interest that they've made it a focus of their training/education. FM programs also emphasize behavioral health to a varied degree - some much more than others.
I agree that the number actually doing formal therapy for a sufficient amount of time with patients is likely very small, but don't sell FM training short. I think if this was something you wanted to pursue you could have developed the foundational training necessary to do it, just like you did with some of those procedures. It would only really be worth it if it was something you were interested in though, like anything else.
But, you still probably won't be able to bill/get paid for therapy codes.
Haha, fair enough. Probably true except as noted above by @InvestingDoc .
Yeah, but coding for it is one thing. Getting paid is another. Plus, there's a chance that it could flag an audit if you do it often enough. Once an insurance company or (worse) CMS is going through your charts, may God have mercy on your soul.
I would bet that you get audited all the time and just don't know it.
Dunno. I've never had to pay back anything for overbilling, though. Once that happens, I imagine you're going to get audited more frequently.
You usually don't have to physically write a check if they ask for you to pay it back. The insurance company sends your biller a notice to "recoup" electronically and they just deduct it from a future payment if you don't write a check within a certain timeframe. If that ever happens to us, we appeal and have won the appeal every time but once.
No kidding. There is no way my corporate overlords would get a smaller-than-expected check and not let me know that it was my fault.I would still know if it happened.
No kidding. There is no way my corporate overlords would get a smaller-than-expected check and not let me know that it was my fault.
Outside of osteoporosis or previously diagnosed vitamin D deficiency, I have given up on ordering Vitamin D for just that reason. It never gets paid for.Yeah, our docs are even charged back for labs performed at our central lab that get denied because of inappropriate coding (lack of medical necessity). The most common ones some people (not me) get nailed for are HgbA1c and vitamin D.
Outside of osteoporosis or previously diagnosed vitamin D deficiency, I have given up on ordering Vitamin D for just that reason. It never gets paid for.
How are people supposed to be diagnosed with Vit D deficiency without it being checked? This is the type of stupid crap that makes people hate our healthcare system. I get that its checked too often, but just put limits on how frequently something can be checked and be done with it. Blanket not covering it is stupid. I didn't know my Vit D was in the single digits until my PCP figured he would check.
/rant