99213 vs 99214 with add on code for therapy?

[StayOnTop]

I've heard so many conflicting things. I'm starting out on my own after graduation, didn't get much training on billing. I'm going to be seeing med mgmt follow ups, 30 minutes. Most patients will have at least two conditions (MDD/GAD, ADHD, etc.) with meds. Is this enough for a 99214? When should I go with 99214 vs 99213?

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[calvnandhobbs68]

You're welcome

 

[pike73]

That information is very helpful. With the changes in the criteria to bill for 99214s what percentage of 99213s vs 99214s are outpatient psychiatrists now seeing? 50/50, 80/20? Also does anyone have experience with what insurance companies are now accepting as acceptable ratios of 99213s vs 99214s before reviewing?

 

[wolfvgang22]

99% of the patients I see are 99214 + 90833 therapy. If I can bill a patient 99213 frequently, I send the patient back to primary care, because they don't necessarily need my expertise anymore. They can always come back if they worsen. I'm not in private practice and we have a staffing shortage, not a patient shortage.

 

[clausewitz2]

99% of the patients I see are 99214 + 90833 therapy. If I can bill a patient 99213 frequently, I send the patient back to primary care, because they don't necessarily need my expertise anymore. They can always come back if they worsen. I'm not in private practice and we have a staffing shortage, not a patient shortage.

Quite honestly I am in private practice and I send habitual 99213's back to primary care. Partly financial (they pay substantially less) but mostly because we are wasting each other's time.

I do have some 99213's i am doing 90838 on a regular basis with but that's very different.

 

[StayOnTop]

So, let's say I see a patient with MDD and GAD on sertraline, stable, but checking in to make sure that side effects are manageable, some issues, but continuing dose as is. Could I bill a 99214 based on MDM? Based on the PDF that was posted, sounds like it, but wanted to be sure.

 

[jbomba]

To piggy back off another thread about taking insurance....how many of you had trouble getting on insurance panels? Wondering how likely I might be told I'm not needed when I try to get credentiales.

 

[clozareal]

It really depends on your practice setting. Fr most, a vast majority should be 99214 but with the 2021 changes, a higher proportion could meet criteria for 99215 than before. Some of the numbers you see about having below 5% be 99215 otherwise you risk an audit are outdated.

For 99213's, this is pretty tough to meet 1 stable chronic illness. That means that you have someone without any co-morbidities, with fully treated depression, ADHD, or anxiety who is in remission and not experiencing any more symptoms causing impairment/distress. The DHSS considers any depression, anxiety, or other mental health condition that is not fully in remission to be currently active (chronic illness with exacerbation, progression, or side effects).

 

[clozareal]

So, let's say I see a patient with MDD and GAD on sertraline, stable, but checking in to make sure that side effects are manageable, some issues, but continuing dose as is. Could I bill a 99214 based on MDM? Based on the PDF that was posted, sounds like it, but wanted to be sure.

what do you mean by stable? like no more symptoms of either that are causing impairment? regardless, if you have those two diagnoses that are stable, it would meet MDM for moderate. if you are monitoring for side effects and giving recommendations on how to manage them, that would meet criteria for prescription medication management which would be moderate. With those two, it would be considered 99214.

 

[wolfvgang22]

So, let's say I see a patient with MDD and GAD on sertraline, stable, but checking in to make sure that side effects are manageable, some issues, but continuing dose as is. Could I bill a 99214 based on MDM? Based on the PDF that was posted, sounds like it, but wanted to be sure.

Yes.

I should be billing 99215 a lot more, but many patients I see have limited income and the problems that come with that and while I am trying to help them manage all their social issue I forget.

 

[clozareal]

I should be billing 99215 a lot more, but many patients I see have limited income and the problems that come with that and while I am trying to help them manage all their social issue I forget.

One of the goals for the 2021 changes is to incentivize physicians/psychiatrists to take on more complex cases with a higher reimbursement rate.

 

[StayOnTop]

This is so enlightening because I work with older psychiatrists who still refuse to bill higher than 99213 + 90833. I don't know if it's fear of auditing or what.

 

[nexus73]

This is so enlightening because I work with older psychiatrists who still refuse to bill higher than 99213 + 90833. I don't know if it's fear of auditing or what.

I know an older psych who never bills psychotherapy even though he has long appointments. He’s afraid of an audit.

 

[splik]

It really depends on your practice setting. Fr most, a vast majority should be 99214 but with the 2021 changes, a higher proportion could meet criteria for 99215 than before. Some of the numbers you see about having below 5% be 99215 otherwise you risk an audit are outdated.

It's actually harder imo (at least in my practice) for me to code level 5s based on MDM now than previously. I used to do 99205+90838 for initial visits previously, but with the new changes I usually have to do 99204+90838 nowadays. And yes, the expectation for most people is that 99215 is used infrequently and you will likely be flagged if you are using 99215 more than 5% of the time, especially if not based on time. Hell, nowadays people are getting audited for using 99214. And because a large proportion of psychiatrists do not know how to document for level 4, they don't pass their audits.

 

[reca]

And because a large proportion of psychiatrists do not know how to document for level 4, they don't pass their audits.

Totally just asking for a friend but uhhhh, where should early career psychiatrists who didn't learn how to document for billing during residency learn how to document to pass an audit?

 

[splik]

Totally just asking for a friend but uhhhh, where should early career psychiatrists who didn't learn how to document for billing during residency learn how to document to pass an audit?

The insurance companies and AAPC provide some useful information as do AMA, APA, and AACAP. What is recommended is that you have audits of your own work done at least annually. I do audits for groups and solo practices and also medical necessity reviews for insurance companies in contested cases (where they might go to court) but there are many people who provide such services.

 

[nexus73]

It's actually harder imo (at least in my practice) for me to code level 5s based on MDM now than previously. I used to do 99205+90838 for initial visits previously, but with the new changes I usually have to do 99204+90838 nowadays. And yes, the expectation for most people is that 99215 is used infrequently and you will likely be flagged if you are using 99215 more than 5% of the time, especially if not based on time. Hell, nowadays people are getting audited for using 99214. And because a large proportion of psychiatrists do not know how to document for level 4, they don't pass their audits.

Hasn’t documenting to level 4 become much easier. What mistakes are being made these days?

 

[deleted1100659]

Can you bill 20 min follow ups with the 90833 therapy code in addition to the 99213, or is the time spent too short? In residency did a lot of 213+90833 but also the appts were 30 min.

 

[clozareal]

It's actually harder imo (at least in my practice) for me to code level 5s based on MDM now than previously. I used to do 99205+90838 for initial visits previously, but with the new changes I usually have to do 99204+90838 nowadays. And yes, the expectation for most people is that 99215 is used infrequently and you will likely be flagged if you are using 99215 more than 5% of the time, especially if not based on time. Hell, nowadays people are getting audited for using 99214. And because a large proportion of psychiatrists do not know how to document for level 4, they don't pass their audits.

If you're doing a consultation model, I would imagine that level 5's would be easier since you would have extensive record review and high level of problem(s), meeting criteria for level 5 MDM even without the risk of complications/M&M from patient management.

 

[rjs2131]

If you're doing 30 min follow-ups, the majority of your visits should be a 99214 + 90833. If you're spending 30 min on follow-ups and not using therapy add-on codes, that's usually somewhere around $100/hr you're missing out on. Extrapolate that out and that could be the difference between a 200k and 300k+ income each year. As long as your documentation supports 16+ minutes of psychotherapy (there are number of ways to document this and some insurance companies want it done a specific way), you can use 90833. I generally include start/end time of the appointment, specific type of therapy and therapy targets.

 

[splik]

If you're doing a consultation model, I would imagine that level 5's would be easier since you would have extensive record review and high level of problem(s), meeting criteria for level 5 MDM even without the risk of complications/M&M from patient management.

For me, it is much much harder because the level of MDM they want is higher. Contrary to what your understanding is, they actually expect you to use level 5 LESS not more with these changes. It is much easier to meet requirements for level 4, but the bar for level 5 is higher. The bar is higher than it was. My patients are complex, but I don't always talk to collateral, or connect with other physicians on the same day, and most of these patients don't meet the "severe exacerbation" or "threat to bodily function" severity, and I'm infrequently dealing with drug therapy "with intensive monitoring for toxicity" or hospitalizing people.

Depending on the setting I usually bill on time to capture things, but if I'm billing insurance I do E&M + psychotherapy since I won't reimbursed for 99417 (or at least not the large number I would put).

 

[Stagg737]

That information is very helpful. With the changes in the criteria to bill for 99214s what percentage of 99213s vs 99214s are outpatient psychiatrists now seeing? 50/50, 80/20? Also does anyone have experience with what insurance companies are now accepting as acceptable ratios of 99213s vs 99214s before reviewing?

If you're billing less than 90% 99214 then you've either got an atypical patient population or are billing incorrectly.

So, let's say I see a patient with MDD and GAD on sertraline, stable, but checking in to make sure that side effects are manageable, some issues, but continuing dose as is. Could I bill a 99214 based on MDM? Based on the PDF that was posted, sounds like it, but wanted to be sure.

If you document it appropriately then yes, this would meet 99214 criteria. One of my attendings in med school had a patient population where 80% or more were stable on 2-3 meds with 2-3 diagnoses. Did 15 minute f/ups and almost all 99214s. We could argue the ethics of that set-up, but the billing was completely appropriate.

This is so enlightening because I work with older psychiatrists who still refuse to bill higher than 99213 + 90833. I don't know if it's fear of auditing or what.

For many it's just a lack of understanding billing requirements. Some people aren't really aware of the newer system and some people are just fine coasting with what they've been doing and leaving that money on the table because they've become complacent. Some are legitimately afraid of being audited. I've even had to educate a few of my attendings regarding add-on codes or criteria because their normal practice doesn't usually involve certain codes. Most recently I was talking to an attending about the 99406/407 codes for nicotine cessation counseling and modifier 25. I only know 1 or 2 attendings who actually utilize those codes, even though several of them are aware of them.

 

[Stagg737]

For me, it is much much harder because the level of MDM they want is higher. Contrary to what your understanding is, they actually expect you to use level 5 LESS not more with these changes. It is much easier to meet requirements for level 4, but the bar for level 5 is higher. The bar is higher than it was. My patients are complex, but I don't always talk to collateral, or connect with other physicians on the same day, and most of these patients don't meet the "severe exacerbation" or "threat to bodily function" severity, and I'm infrequently dealing with drug therapy "with intensive monitoring for toxicity" or hospitalizing people.

Depending on the setting I usually bill on time to capture things, but if I'm billing insurance I do E&M + psychotherapy since I won't reimbursed for 99417 (or at least not the large number I would put).

So are you able to bill a 99214/215 based on time AND 90833 in the same appointment? Can the time spent on the 90833 requirements also count toward the 992__ billing time or does it have to be completely separate? Not as familiar with the 90833 add-on as I'd like to be as we're not allowed to use it and also can't bill based on time at my program.

 

[ObsequiousAplomb]

So are you able to bill a 99214/215 based on time AND 90833 in the same appointment? Can the time spent on the 90833 requirements also count toward the 992__ billing time or does it have to be completely separate? Not as familiar with the 90833 add-on as I'd like to be as we're not allowed to use it and also can't bill based on time at my program.

From my understanding, no, the use of a timed add-on psychotherapy 90833/90836/90838 means that MDM must be the determining factor for the E&M code. So while a 60 minute session could be coded as 99214/90836 or 99214/90838 depending on whether 38-53 or 53+ of those 60 minutes were psychotherapy.

Making it a 90 minute encounter would not mean you could bill it as 99215/90838 based on time alone (37 + 53, with an additional 3+ minutes on non-face-to-face billable time). Granted, if you need to spend 90 minutes on an encounter, I sure hope it's complex enough that the MDM qualifies for 99215.

 

[deleted1100659]

are you guys doing 20 min follow ups as 99213+90833, something like 16 min therapy+4 min med management?

 

[TexasPhysician]

are you guys doing 20 min follow ups as 99213+90833, something like 16 min therapy+4 min med management?

Theoretically that seems very reasonable to me. A 99213 is rare to benefit from therapy in my population. Most of my patients that are 99213 are ADHD. If you have a pure specific phobia patient and do 16 minutes of therapy, 4 minutes of med management is likely plenty.

 

[Stagg737]

Theoretically that seems very reasonable to me. A 99213 is rare to benefit from therapy in my population. Most of my patients that are 99213 are ADHD. If you have a pure specific phobia patient and do 16 minutes of therapy, 4 minutes of med management is likely plenty.

Agree, in my limited experience the true 99213s are usually the stable patients just there for their med refills and probably only need 5ish minutes. You could probably get all the billable info needed from them filling out a form in the waiting room. Also agree with previous posters that most 213s can probably be kicked back to their PCP fairly quickly unless their PCP doesn't want to prescribe stimulants.

I do have some 99213's i am doing 90838 on a regular basis with but that's very different.

I'm actually very curious about what this population would be. Can't really think of much other than maybe patients you're doing intensive psychodynamic work with.

 

[calvnandhobbs68]

Agree, in my limited experience the true 99213s are usually the stable patients just there for their med refills and probably only need 5ish minutes. You could probably get all the billable info needed from them filling out a form in the waiting room. Also agree with previous posters that most 213s can probably be kicked back to their PCP fairly quickly unless their PCP doesn't want to prescribe stimulants.


I'm actually very curious about what this population would be. Can't really think of much other than maybe patients you're doing intensive psychodynamic work with.

I have some patients I do weekly CBT (primarily) with that I bill 99213 + 90836, really just treating one condition with one med. One of them I could probably technically bill 99214 every week since technically they have two conditions and not exactly stable but I don't feel like playing the "try for an audit" game. I tend to bill a 99214 whenever I end up changing something med-wise with them. Could probably get away billing them as 90838s since I spend almost an hour with them every time but whatever.

I think there's a difference between trying to force a therapy encounter with a 99213 10 minute med check patient vs doing regular therapy with a fairly stable patient that also requires some medical management (ex. patient with GAD on Lexapro you're doing weekly CBT/psychodynamic therapy with). Technically I guess you could say it's an unstable chronic condition because they aren't at goal yet (thus in weekly therapy) but I'd rather not light up insurance flags with wondering why I'm billing 99214s every week for 2 months straight for a patient, how reasonable or not that may be. I also for instance regularly bill 99213 + 90833 for child patients even if they're pretty stable and I won't see them again for 3 months, if for instance I had to spend some time talking to a parent about behavioral management, psychoeducation about course of the condition, setting expectations, etc (cause most child encounters are very rarely <25min long if you're doing it right even if a kid is fairly stable). Otherwise I just do a 99214 based on time if I don't think I provided any therapy during the encounter (which ends up coming out to less than 99213 + 90833 by about 30 bucks in my panels).

 

[clausewitz2]

Had additional questions on psychotherapy add-on codes...

1) Can you use 99213/99214 E&M code and use add-on 90833 psychotherapy code for 20 minute f/u visit?

Good luck explaining how you managed meaningful medical decision making at the 99214 level in just four minutes. 99213 would not be so hard.

2) Can you use 99204/99205 E&M code for a 60 min new eval and also use 90833 psychotherapy code since you are seeing the patient >53 face-to-face?

Did you mean 90838? Good luck justifying a 99204 level of MDM for a patient you have never met before in 7 minutes. The therapy portion has to be separate from E&M.

99204 + 90833, however, is very definitely doable

 

[justordinary]

Good luck explaining how you managed meaningful medical decision making at the 99214 level in just four minutes. 99213 would not be so hard.



Did you mean 90838? Good luck justifying a 99204 level of MDM for a patient you have never met before in 7 minutes. The therapy portion has to be separate from E&M.

99204 + 90833, however, is very definitely doable

got it... then i guess 99213/99214 + 90833 is more doable with 30min f/u?? in case of hypothetical audit....

 

[WisNeuro]

From someone who has a pretty extensive therapy training background. The thought of considering 16 minutes of something to be actual therapy and being able to bill for it seems almost criminal to me.

 

[splik]

Good luck explaining how you managed meaningful medical decision making at the 99214 level in just four minutes. 99213 would not be so hard.

Honestly I have more of an issue someone claiming they are doing 16mins of therapy, than 4 minutes of 99214. I dont do much straight psychopharm stuff myself these days, but I have one pt who I am seeing for about 5 mins a visit w/ TBI and psychosis and cross-tapering some meds. Basically frequently check ins to make sure not decompensating. Definitely meets criteria for 99214. I have a harder time with people claiming they are providing medically necessary "therapy" in 16 mins.

 

[clausewitz2]

Honestly I have more of an issue someone claiming they are doing 16mins of therapy, than 4 minutes of 99214. I dont do much straight psychopharm stuff myself these days, but I have one pt who I am seeing for about 5 mins a visit w/ TBI and psychosis and cross-tapering some meds. Basically frequently check ins to make sure not decompensating. Definitely meets criteria for 99214. I have a harder time with people claiming they are providing medically necessary "therapy" in 16 mins.

5 minute visits certainly seem reasonable in instances like you are outlining, but I think it is fair to say that that is not the modal 99214. I think the 16 minute add-on code is clearly an attempt to incentivize longer, more psychologically-minded visits, and this is not a bad thing. I agree that calling some of what goes on to justify these 90833s 'therapy' is rubbish. That said, as someone who works with a fair number of people with psychosis, CT-R absolutely lends itself to doing this even with that population much of the time.

From someone who has a pretty extensive therapy training background. The thought of considering 16 minutes of something to be actual therapy and being able to bill for it seems almost criminal to me.

I have the same intuition you do even as someone who does bill this all the time, but I'm not sure what else to call it but 'therapy' without inventing new jargon. If I do a mindful awareness and values identification exercise straight from God Steve Hayes' mouth with a patient after previously introducing relevant ACT concepts and instilled appropriate creative hopelessness, is that

a) utterly useless

or

b) not worthy of reimbursement

Just because it is not happening as part of weekly hourly sessions? I am not saying it is necessarily straightforward but I think there is a way to do this that violates the intuition about what should count as therapy to a greater or lesser degree.

 

[calvnandhobbs68]

From someone who has a pretty extensive therapy training background. The thought of considering 16 minutes of something to be actual therapy and being able to bill for it seems almost criminal to me.

Or I guess I could just bill 4x 99214s an hour with "med checks". It's kind of pick your poison. If you want psychiatrists who actually spend 30 minutes with their patients to followup, there also has to be a way to get paid for this, especially outside of academic centers who do their own scamming by throwing on hospital "facility fees" onto your billing. Part of this is a function of trying to level reimbursement for psychiatry so people actually want to do it. Instead of going into specialities where you can string together 6 99213s an hour or do 3 endoscopies in the time it takes me to do an intake.

Also, given the quality of some of the "therapy" I see in the community (i've said this over and over before....), I feel 0 guilt for billing a 90833 after spending a decent portion of the visit doing basic CBT stuff like identifying automatic thoughts, reinforcing the thought/feeling/behavior link, etc etc. Its more than I see some people do who are apparently "therapists" but most of their appointments seem to be talking to the patient about their dog or something.

 

[justordinary]

Or I guess I could just bill 4x 99214s an hour with "med checks". It's kind of pick your poison. If you want psychiatrists who actually spend 30 minutes with their patients to followup, there also has to be a way to get paid for this, especially outside of academic centers who do their own scamming by throwing on hospital "facility fees" onto your billing. Part of this is a function of trying to level reimbursement for psychiatry so people actually want to do it. Instead of going into specialities where you can string together 6 99213s an hour or do 3 endoscopies in the time it takes me to do an intake.

Also, given the quality of some of the "thearpy" I see in the community (i've said this over and over before....), I feel 0 guilt for billing a 90833 after spending a decent portion of the visit doing basic CBT stuff like identifying automatic thoughts, reinforcing the thought/feeling/behavior link, etc etc. Its more than I see some people do who are apparently "therapists" but most of their appointments seem to be talking to the patient about their dog or something.

Completely agree with you. If there is a code for 90833 and if I do spend 16-37 min with the patient, then why would you not bill for it? Regardless of it's 16 min or 37min. You gotta keep the lights on and pay the bills, after all.
I guess i was confused about using e/m code because the update said you can use either mdm OR time spent to bill for e/m code. But if you have to justify the time spent to make the mdm, (like how you can't really justify billing 99214+90833 because you can't really spend only 4min doing mdm for 99214 complexity, if I understand correctly?) then why even distinguish between mdm and time spent??

 

[WisNeuro]

Or I guess I could just bill 4x 99214s an hour with "med checks". It's kind of pick your poison. If you want psychiatrists who actually spend 30 minutes with their patients to followup, there also has to be a way to get paid for this, especially outside of academic centers who do their own scamming by throwing on hospital "facility fees" onto your billing. Part of this is a function of trying to level reimbursement for psychiatry so people actually want to do it. Instead of going into specialities where you can string together 6 99213s an hour or do 3 endoscopies in the time it takes me to do an intake.

Also, given the quality of some of the "therapy" I see in the community (i've said this over and over before....), I feel 0 guilt for billing a 90833 after spending a decent portion of the visit doing basic CBT stuff like identifying automatic thoughts, reinforcing the thought/feeling/behavior link, etc etc. Its more than I see some people do who are apparently "therapists" but most of their appointments seem to be talking to the patient about their dog or something.

I don't blame you guys for using it, I want to get reimbursed for my time, too. I just wish that that there were another billing code so that it wasn't conflated with actual therapy.

 

[nexus73]

I don't blame you guys for using it, I want to get reimbursed for my time, too. I just wish that that there were another billing code so that it wasn't conflated with actual therapy.

There are different types of therapy, with varying intensities, durations, goals, etc. Not all therapy is manualized CBT requiring X number of 60 minute sessions. There's no reason to be dismissive. If I'm managing medications and ALSO doing 20 minutes of supportive psychotherapy as part of a monthly visit, I think this is better for patient care, and the patients prefer it, and it leads to better medication management in my opinion. This patient could also being seeing a therapist for weekly hour long sessions focusing on CBT/DBT/ACT what have you and getting into deeper issues and working towards longer term goals, and I don't see a problem with it.

 

[WisNeuro]

There are different types of therapy, with varying intensities, durations, goals, etc. Not all therapy is manualized CBT requiring X number of 60 minute sessions. There's no reason to be dismissive. If I'm managing medications and ALSO doing 20 minutes of supportive psychotherapy as part of a monthly visit, I think this is better for patient care, and the patients prefer it, and it leads to better medication management in my opinion. This patient could also being seeing a therapist for weekly hour long sessions focusing on CBT/DBT/ACT what have you and getting into deeper issues and working towards longer term goals, and I don't see a problem with it.

I am very aware of different types of therapy, I am well trained in many CBT, third wave, and psychodynamic approaches. But, I am skeptical of any incremental value to 20 minutes of "supportive" therapy above and beyond simply having someone to talk to, which can be achieved much more cheaply.

 

[calvnandhobbs68]

I am very aware of different types of therapy, I am well trained in many CBT, third wave, and psychodynamic approaches. But, I am skeptical of any incremental value to 20 minutes of "supportive" therapy above and beyond simply having someone to talk to, which can be achieved much more cheaply.

Cheaper than 65-70 bucks? Cause that's my range for a 90833. I mean yeah if you wanted to pay the whole 90837 cost for an hour long therapy appointment (which usually comes out to ~140-145/visit for our insurance panels) then yes I suppose you get a longer time period of "someone to talk to" which again....is a very variable quality set. I mean I'm skeptical of the incremental value of many of these supposedly real "therapy" visits. I think the core issue needs to be if you can specify what exactly you're providing

Also, this has been brought up in the past but these codes were never truly meant to suggest that you take 9:00-9:16 and spend that doing "psychotherapy" and then 9:16-9:30 and spend that doing "E+M"...the APA has stated this in the past. They were meant to provide value for actually spending time reviewing psychotheraputic principles with patients in the context of the larger visit rather than incentivizing psychiatrists to do 10-15min "med checks". This then got bastardized by insurance companies to say "you need to say this is two separate time periods". So we play the game with documentation.

Quality not quantity

 

[WisNeuro]

Cheaper than 65-70 bucks? Cause that's my range for a 90833. I mean yeah if you wanted to pay the whole 90837 cost for an hour long therapy appointment (which usually comes out to ~140-145/visit for our insurance panels) then yes I suppose you get a longer time period of "someone to talk to" which again....is a very variable quality set. I mean I'm skeptical of the incremental value of many of these supposedly real "therapy" visits. I think the core issue needs to be if you can specify what exactly you're providing

Also, this has been brought up in the past but these codes were never truly meant to suggest that you take 9:00-9:16 and spend that doing "psychotherapy" and then 9:16-9:30 and spend that doing "E+M"...the APA has stated this in the past. They were meant to provide value for actually spending time reviewing psychotheraputic principles with patients in the context of the larger visit rather than incentivizing psychiatrists to do 10-15min "med checks". This then got bastardized by insurance companies to say "you need to say this is two separate time periods". So we play the game with documentation.

Quality not quantity

On this, we agree, I just don't believe supportive therapy is quality.

 

[nexus73]

On this, we agree, I just don't believe supportive therapy is quality.

Why don’t you think supportive psychotherapy is quality?

I mean, it’s not psychoanalysis but it’s pretty good.

 

[WisNeuro]

Why don’t you think supportive psychotherapy is quality?

I mean, it’s not psychoanalysis but it’s pretty good.

Part of it depends on how you define supportive therapy, as it's a very wide range. In most cases, it's just "Crisis of the week/month" stuff, and somewhere between 16-20-something minutes. Haven't seen any good data on that. There is some data on more traditional TAU, close to traditional length sessions. But, the data there is still pretty limited, mostly in depression, and doesn't seem to do much better than WLC participants.

 

[Alemo]

Probably a good time to mention that "providing psychotherapy" has been difficult to operationalize for over a century, and that the mechanism by which psychotherapy helps is hard to pinpoint- the so-called contextual understanding of psychotherapy.

 

[calvnandhobbs68]

On this, we agree, I just don't believe supportive therapy is quality.

lol I'm gonna be real and go out on a limb and say I consider myself providing much more value doing 20 minutes of introducing the principles of automatic thinking, reviewing an automatic thought worksheet and giving the patient homework to identify automatic thoughts to discuss at our followup visit than I see some therapists doing in 50 minute visits

 

[WisNeuro]

lol I'm gonna be real and go out on a limb and say I consider myself providing much more value doing 20 minutes of introducing the principles of automatic thinking, reviewing an automatic thought worksheet and giving the patient homework to identify automatic thoughts to discuss at our followup visit than I see some therapists doing in 50 minute visits

I mean, if the comparison of supportive therapy is with someone half-assing CBT, then sure, they're probably equally efficacious.

 

[calvnandhobbs68]

I mean, if the comparison of supportive therapy is with someone half-assing CBT, then sure, they're probably equally efficacious.

and they're still billing for their hour of supportive therapy so I might as well bill for my half-assed CBT amirite

 

[WisNeuro]

and they're still billing for their hour of supportive therapy so I might as well bill for my half-assed CBT amirite

Sure, I don't consider either actually doing therapy, but people are free to legally bill for it. Ethically, on the other hand, well, we all have what we can live with.

 

[Alemo]

What’s half ass about that CBT description though?

 

[justordinary]

A clinic I used to work at routinely billed 99213/99214 + 99033 for 30 min visit.... I don't think anyone there faced any trouble, as long as they had proper documentation. I think the "quality of therapy provided" is a different issue, and auditors are not gonna care about this "quality"... they're not gonna sit in your office, analyze your conversation with each patient and assess the "quality of your therapy."

Obviously, I don't know any place that does 20 min visits and how they bill. I've heard clinics that have 15min visits utilize 99213/99214, for obvious reasons.

 

[futureapppsy2]

If I do a mindful awareness and values identification exercise straight from God Steve Hayes' mouth with a patient after previously introducing relevant ACT concepts and instilled appropriate creative hopelessness, is that

You joke, but in hardcore ACT circles, I've often wanted to shout "Steve Hayes is not atheist Jesus and did not invent mindfulness!" And I really like ACT, but some of these people are just over the top--including someone who told me he liked ACT because he was "too smart" for CBT.