90833 documentation requirement with E&M code?

[nrmp]

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How do you document time spent? For example total 18 minutes spent on therapy or do you need to specify start and end time in specific spent on therapy? I am billing E&M based on complexity but not clear on therapy add-on.

Also what else do you document about therapy interventions? Do you need more details with goal/objectives and progress or just list interventions provided? Are you guys getting denials based on lack of enough documentation? Thank you

 

[romanticscience]

This is what I write:

Psychotherapy
No obstacles to treatment frame/GOALS. XX-minutes (Start 0X:00, Stop 0X:20) of individual THERAPY TYPE psychotherapy provided with a focus on MAJOR THEME OF THE SESSION (eg, role transitions/disputes as manifested in xyz, conflicted-EMOTION as manifested in xyz, maintaining self-esteem through/evoking motivation to).

 

[Sushirolls]

I've seen this used:

Separate from the evaluation and management portion of today's visit, a psychotherapy procedure was performed. Primarily used today was [supportive therapy, insight oriented, CBT, etc] for a total of [##]min. Brief therapy notes in addition to HPI, include: [stuff goes here]. Progress today is rated as [stuff goes here].

 

[nrmp]

Thank you. Do you guys use therapy add-on code for new evals?

 

[Sushirolls]

Not on new evals. 90792, I don't believe insurance will even consider it. You might get it thru on 99204/99205. But I wouldn't get your hopes up.

 

[285963]

Can 90833 be combined with inpatient hospital subsequent care E&M codes? (i.e., 99231-3)

 

[Sushirolls]

Yes

 

[romanticscience]

I use the therapy add-on with 99204/99205 (need vital signs) for new evals. No problem with insurance.

I use a wrist BP cuff which assesses heart rate. I record the vitals while asking about allergies, med conditions, and hospitalizations.

 

[Sushirolls]

I do pulse oximeter & weight for 3 vital signs

 

[wolfvgang22]

I've seen this used:

Separate from the evaluation and management portion of today's visit, a psychotherapy procedure was performed. Primarily used today was [supportive therapy, insight oriented, CBT, etc] for a total of [##]min. Brief therapy notes in addition to HPI, include: [stuff goes here]. Progress today is rated as [stuff goes here].

This is what I use.

 

[nrmp]

I use the therapy add-on with 99204/99205 (need vital signs) for new evals. No problem with insurance.

I use a wrist BP cuff which assesses heart rate. I record the vitals while asking about allergies, med conditions, and hospitalizations.

Good to know. I have tried for couple patients, hopefully will go through.

 

[Taddy Mason]

Just a lowly resident but we do our own billing and I do 9920x/9083x for new patients and 9921x/9083x for follow-ups and have yet to run into any issues.

 

[Orgone]

Not on new evals. 90792, I don't believe insurance will even consider it. You might get it thru on 99204/99205. But I wouldn't get your hopes up.

90792 it's not allowed, I forget the "reason", I started out billing that way and the add ons were all rejected. But my local insurers have reimbursed with 99204 no problem. 99204 pays more anyway.

 

[NickNaylor]

I don't use the therapy add-on codes but I do make judicious use of the prolonged service codes. Our ECT evaluations are typically scheduled for ~2 hours and may go to 2.5 depending on how much discussion we have. It's possible I just haven't heard from our billing folks yet, but thus far I haven't had any trouble billing these codes.

 

[splik]

I don't use the therapy add-on codes but I do make judicious use of the prolonged service codes. Our ECT evaluations are typically scheduled for ~2 hours and may go to 2.5 depending on how much discussion we have. It's possible I just haven't heard from our billing folks yet, but thus far I haven't had any trouble billing these codes.

Medicare usually pays for prolonged services codes for patients. If you use it frequently you will be audited at some point. However, given that ECT patients are often high risk or have refractory illness you would be able to provide a very satisfactory justification for medical necessity if audited. And of course it would not be appropriate to use therapy add on codes for an ECT evaluation. Commercial insurances often do not to pay for prolonged services codes. In which case the cost will be written off or passed on to the patient. Remember to document start and stop times for the visit and the reason for prolonged services, otherwise you cannot bill for it.

 

[splik]

90792 it's not allowed, I forget the "reason", I started out billing that way and the add ons were all rejected. But my local insurers have reimbursed with 99204 no problem. 99204 pays more anyway.

90792 is not an E&M code and thus you cannot use psychotherapy add-on codes with it. You can only use the add-on codes with the E&M codes including 99201-5, 99221-5, 99241-5, 99221-3, 99231-3. Thus add on codes can be used on new patients, on inpatients, on the psychiatry consult service, in the ED (if using outpatient codes), and for outpatient consults when using E&M codes.