Billing for weekly therapist+med management

[roastedcapers]

I'm meeting with a few clients weekly for therapy with med management. Most of the time is spent doing psychotherapy with occasional dose changes. I am new to billing insurance. I billed one so far as 99213+90836 (15 mins meds plus 45 mins therapy). Does this make sense? I'm concerned that the insurance company will view it as overbilling if something like this comes in every week for a client. Would it be better to do 90837 most weeks and then one week a month do 99214 plus 90833? It seems like the first option overestimates how much time we spend discussing meds and the second option underestimates. Also, it's not like all the med discussion is necessarily confined to one session per month. Maybe I'm way overthinking this. Thanks for any feedback.

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[splik]

yes you are overthinking this. As a psychiatrist, it is most likely appropriate for you to bill E&M codes with psychotherapy add ons for every therapy visit, with the possible exception of patients you are seeing for split treatment (i.e. they see someone for psychopharm and you see them for psychotherapy only). At a minimum each visit should be 99212+90836, and most likely 99213+90836 and 99214+90836 for more complex patients. Most of my visits are for therapy, I never prescribe meds, and I most commonly use 99214+90836.

In my experience, insurance companies are quite happy to pay for E&M visits; they are much less happy paying for endless psychotherapy. So doing both is actually good, and there is some data that integrated treatment is more cost-effective than split treatment.

 

[hamstergang]

I billed one so far as 99213+90836 (15 mins meds plus 45 mins therapy).

If you use the add-on psychotherapy codes, then you have to build the E&M portion based on complexity not time.

 

[psyguru]

yes you are overthinking this. As a psychiatrist, it is most likely appropriate for you to bill E&M codes with psychotherapy add ons for every therapy visit, with the possible exception of patients you are seeing for split treatment (i.e. they see someone for psychopharm and you see them for psychotherapy only). At a minimum each visit should be 99212+90836, and most likely 99213+90836 and 99214+90836 for more complex patients. Most of my visits are for therapy, I never prescribe meds, and I most commonly use 99214+90836.

In my experience, insurance companies are quite happy to pay for E&M visits; they are much less happy paying for endless psychotherapy. So doing both is actually good, and there is some data that integrated treatment is more cost-effective than split treatment.

How come you don't prescribe meds?

 

[NickNaylor]

As @hamstergang said, make sure you are billing the E&M portion of the visit based on complexity rather than time if you are using psychotherapy add-ons. Also, make sure that you're including the necessary documentation for psychotherapy billing. CMS has guidelines for this (you need to document the treatment plan, therapeutic goals, techniques/maneuvers utilized, time spent performing psychotherapy, and outcomes), but private payers may have different requirements. Depending on your EMR, you can easily set this up to be drop-down lists or quick free text to fill in the necessary components.