Billing with Counselor Question

[TexasPhysician]

I get that an in-house counselor can see a patient and bill a counseling code. Insurance won’t cover if I bill a counseling add-on code the same day as the counselor in-house bills for their service.

Instead of ever using a midlevel/APP, could we utilize counselors in a similar way. Say someone comes in for therapy. X minutes are therapy and Y minutes are getting med updates. If I then get sign out from the counselor, co-sign their note, and add my own, could I bill 99214 + 99833 (or similar) instead of billing separately? Ignore reimbursement. Is this legal?

I’m wondering if this also wouldn’t be a way to provide better care. Everyone would essentially get counseling.

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[Sushirolls]

I tend to think how will the insurance companies evaluate gray areas so as we get the raw deal?

I don't see why it would be illegal, if a therapist/psychologist submits to a contract that requires supervision in this fashion.

 

[calvnandhobbs68]

It's an interesting question...not sure.

The descriptions of the add-on codes state they have to be submitted by an MD, DO or "NPP" (NP/PA) so they can't be submitted by an PhD, LCSW, LPCC, etc. It also says it has to be "face to face time" but it doesn't necessarily say for who. I'd assume though it would be for the same person that submitted the E+M service if it's open to interpretation.

If you're saying you're getting "med updates" from a therapist without doing the E+M portion yourself, that definitely wouldn't fly because they're never eligible to bill an E+M code.

 

[TexasPhysician]

It's an interesting question...not sure.

The descriptions of the add-on codes state they have to be submitted by an MD, DO or "NPP" (NP/PA) so they can't be submitted by an PhD, LCSW, LPCC, etc. It also says it has to be "face to face time" but it doesn't necessarily say for who. I'd assume though it would be for the same person that submitted the E+M service if it's open to interpretation.

If you're saying you're getting "med updates" from a therapist without doing the E+M portion yourself, that definitely wouldn't fly because they're never eligible to bill an E+M code.

I’d still see each patient each time to do E&M. The duration may be shorter with me, but counseling would come as a package deal.

Credentialing new counselors when brought on to fill this role, 90837 documentation would be more burdensome than add-ons for me, etc. The positives exist.

I’m probably overthinking this, but it sounded like an idea worth exploring.