Therapy for billing purposes is not the same as real therapy for treatment. You certainly can pull in elements of actual psychotherapy and hope that it actually improves patient outcomes. But as you point out, 16 minutes once per month is rather substandard care and therefore should not be thought of as an actual course of psychotherapy.
If your documentation and clinical care match up with it, go ahead. It will certainly draw more attention than 1 x 99214 & 2 x 99214+90833 in an hour. They can and will audit you whenever they want.So with recent changes to coding is it reasonable to bill 99214 + 90833 for 20 minute appointments and see 3 per hr? I don’t plan to do it for each patient as not every patient needs therapy. Just curious if I see 12 patients in an afternoon from 1 to 5 pm and I bill the combination like 7 times. Would that appear as a red flag
I could see if they were all 99214 + 90833 but about half and a few 99213. I will see more complicated patients and NP's less. My practice manager said I should be billing 99214 almost each time. I am trying to figure out the outpatient world of billing.
7 out of 12 as that combo sounds reasonable to me.
Everything should probably be 99214 but the 90833 should be on only those who need therapy so maybe 50-70 percent? Also if you’re not doing full time outpatient I would imagine this would decrease your chance of an audit since you have many less claims so insurance won’t care as much about you compared to the guy submitting 5x as many claims working full time.
Assuming you spend 2 minutes documenting and prescribing that leaves 2 minutes for the E&M 99214 portion of the appointment in a 20 minute follow up. Does this seem reasonable? At <5 min for the E&M, could you see 12 99214 follow ups in an hour?
recommending CBTi would be E&M, NOT psychotherapy. providing CBTi techniques would count for the 90833.
While the therapy and the E&M components must be separate, you are allowed to take information from one piece and use it in another. That is, the information you obtain during the therapy portion can be used when deciding things about medications. Therefore, a straight E&M appointment would likely take longer than just the E&M component of a combined session.
Document well and you should be fine as long as you’re actually spending quality time with the patient. I wouldn’t use 90833 for 20 min follow ups (only 30).
