CPT Codes

[texanpsychdoc]

I was curious, can psychologists bill for the CPT code 99205? Or is this strictly for physicians?

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[smalltownpsych]

If a psychologist is a medical psychologist in our state then they could in theory, I believe. I have heard that they have had difficulty getting reimbursement from some insurances for some of the evaluation and management codes which are dependent on medical decision making. Regular old psychologists like me, no reason to code that unless I’m practicing outside my scope by cleaning and dressing my patients wounds or telling them to take some Tylenol for that headache.

 

[AcronymAllergy]

Pretty sure it's a hard no as psychologists, as far as I'm aware, don't have the ability to bill E/M codes. Even for RxP, there's a separate CPT code (90863). But it may also vary by state/insurance company.

 

[texanpsychdoc]

On a related note, do people bill other codes as add ons when doing therapy with 90837, or for an initial eval with 90791? For example, is it worth it or possible to add on the 96116 code for a PHQ-9/GAD-7?

 

[AcronymAllergy]

96116 is the neurobehavioral status exam and which is billed per hour. It'd also probably be mutually-exclusive with 90791. I imagine you'd have a hard time justifying to an insurance company how you conducted both a neurobehavioral status exam and an initial psychiatric evaluation on the same day in the same appointment, and in what way(s) the services were different (e.g., in what way the additional hour for a neurobehavioral status exam wasn't just an extension of the untimed 90791). I also wouldn't be surprised if you were just outright prohibited from billing the two codes together for the same patient on the same day (e.g., similar to how neuropsychologists sometimes can't bill 96136 and 96138 together on the same day for the same patient).

I vaguely recall there being a code for completing brief questionnaires like the PHQ-9, but I can't remember what it is. I do remember hearing it was rarely reimbursed, and even when it was, the actual reimbursement was miniscule (i.e., a couple dollars).

 

[WisNeuro]

On a related note, do people bill other codes as add ons when doing therapy with 90837, or for an initial eval with 90791? For example, is it worth it or possible to add on the 96116 code for a PHQ-9/GAD-7?

Are you saying you'd bill both a 90191 and a 96116?

 

[Sanman]

On a related note, do people bill other codes as add ons when doing therapy with 90837, or for an initial eval with 90791? For example, is it worth it or possible to add on the 96116 code for a PHQ-9/GAD-7?

That would not be appropriate billing as both of those screens would fall under the 90791.

 

[texanpsychdoc]

Are you saying you'd bill both a 90191 and a 96116?

...no? I was asking if one could bill for 90791 or 9037 as well as add on a 96116 if you did a PHQ-9 or GAD-7.

That would not be appropriate billing as both of those screens would fall under the 90791.

I ask because I've heard from others who say they do bill the 96116 for those two measures and get like $4 reimbursed.

 

[erg923]

On a related note, do people bill other codes as add ons when doing therapy with 90837, or for an initial eval with 90791? For example, is it worth it or possible to add on the 96116 code for a PHQ-9/GAD-7?

You have to pass the 30 minute mark to use a base code. And obviously a PHQ and GAD wouldn’t take that long or even count for 96116.

 

[texanpsychdoc]

You have to pass the 30 minute mark to use a base code. And obviously a PHQ and GAD would take that long or even count for 96116.

I guess another way to frame my question(s) ....how do people maximize their billable with insurances (ethically)? For me, I am pretty simple in my billing. I see folks for 50 minutes for an initial eval (90791) and 54 minutes for therapy (90837). That's it. I have yet to get some testing folks yet, but I will cross that bridge when I get to it. I've already asked how folks tend to bill for certain batteries on the Testing Psychologist Facebook group, so I have a decent idea how I could efficiently and ethically bill for testing/assessments.

 

[AcronymAllergy]

...no? I was asking if one could bill for 90791 or 9037 as well as add on a 96116 if you did a PHQ-9 or GAD-7.


I ask because I've heard from others who say they do bill the 96116 for those two measures and get like $4 reimbursed.

I wonder if you're getting 96116 confused with another code? 96116 is reimbursed at right around $100 by Medicare, give or take. And basically is done in place of 90791.

I don't know if there's a specific add-on code for administration of brief screening measures. There might be, but I've never used one.

The only thing I could think to add to psychotherapy and interview codes would be interactive complexity (90785) when it's appropriate. I don't know that there's much you can do in terms of improving reimbursement for such via the billing codes themselves. It's more in terms of efficiency and how the clinic and schedules are setup. But maybe I'm wrong.

 

[smalltownpsych]

When I was doing insurance I used the interactive complexity code quite a bit and that added up to some extra revenue. I considered using the brief emotional/behavioral assessment code which is 96127 but never implemented it because it just didn’t seem worth the efforts the place I was working but it might make sense for you.

 

[texanpsychdoc]

I wonder if you're getting 96116 confused with another code? 96116 is reimbursed at right around $100 by Medicare, give or take. And basically is done in place of 90791.

I don't know if there's a specific add-on code for administration of brief screening measures. There might be, but I've never used one.

The only thing I could think to add to psychotherapy and interview codes would be interactive complexity (90785) when it's appropriate.

This is good to know. What would be the circumstance where the 90785 would apply? How would one define and operationalize "interactive complexity?"

 

[AcronymAllergy]

This is good to know. What would be the circumstance where the 90785 would apply? How would one define and operationalize "interactive complexity?"

This site discusses interactive complexity: Psychotherapy codes for psychologists

It's primarily when there are third-parties that need to be involved (e.g., parents, caregivers) and/or communication with the patient is very difficult.

Edit: and directly from the CPT manual:

Interactive complexity may be reported with psychiatric procedures when at least one of the following communication difficulties is present:

1. The need to manage maladaptive communication (related to, e.g., high anxiety, high reactivity, repeated questions, or disagreement) among participants that complicates delivery of care.

2. Caregiver emotions/behavior that interfere with implementation of the treatment plan.

3. Evidence/disclosure of a sentinel event and mandated report to a third party (e.g., abuse or neglect with report to state agency) with initiation of discussion of the sentinel event and/or report with patient and other visit participants.

4. Use of play equipment, physical devices, interpreter or translator to overcome significant language barriers.

 

[PsyDWannabe]

Regarding being “creative“ with insurance billing, you’re supposed to bill for what you did and not bill for what you didn’t do (based on the rates stated in your contract). It really is that simple. Getting too creative could lead to audits and clawbacks which come with way more problems than you need.

 

[texanpsychdoc]

This site discusses interactive complexity: Psychotherapy codes for psychologists

It's primarily when there are third-parties that need to be involved (e.g., parents, caregivers) and/or communication with the patient is very difficult.

Edit: and directly from the CPT manual:

Interactive complexity may be reported with psychiatric procedures when at least one of the following communication difficulties is present:

1. The need to manage maladaptive communication (related to, e.g., high anxiety, high reactivity, repeated questions, or disagreement) among participants that complicates delivery of care.

2. Caregiver emotions/behavior that interfere with implementation of the treatment plan.

3. Evidence/disclosure of a sentinel event and mandated report to a third party (e.g., abuse or neglect with report to state agency) with initiation of discussion of the sentinel event and/or report with patient and other visit participants.

4. Use of play equipment, physical devices, interpreter or translator to overcome significant language barriers.

I just pulled that up lol! Thanks for sharing this tho.

 

[texanpsychdoc]

Regarding being “creative“ with insurance billing, you’re supposed to bill for what you did and not bill for what you didn’t do (based on the rates stated in your contract). It really is that simple. Getting too creative could lead to audits and clawbacks which come with way more problems than you need.

I realize that, and that's not what I'm doing nor plan to do. But I do want to make sure I'm maximizing what I am doing in terms of factual basis. It's interesting you went to the "creative" side of what are just curious questions I have.

 

[smalltownpsych]

If I have to interact with any third party in any way then I code it. If I play any game then I code it. You can also schedule three 40 minute sessions in two hours.

 

[texanpsychdoc]

If I have to interact with any third party in any way then I code it. If I play any game then I code it. You can also schedule three 40 minute sessions in two hours.

good to know. In the end, learning all of this insurance stuff and ensuring I am maximizing payments in terms of what I am factually/actually doing is what I am double checking. You don't know what you don't know, so it's good ask from those who have been at this longer and have more experience. I think these questions I've been asking are absolutely in line with that. I appreciate the insights and thoughts on this.

 

[texanpsychdoc]

Also, to add further context surrounding my initial question about coding the 96116 for PHQ and GAD is because at a former VA I worked at in the pain clinic, our initial eval to the clinic usually consisted of the PHQ, GAD, ACES, and usually a few pain related measures. In the end, my supervisor told me I should code 96116 in addition to 90791 for those encounters, even when the actual measures themselves never took 30 minutes. I would do the interview plus go through those measures probably within in 50 minute time period.

 

[smalltownpsych]

With acceptance of telehealth, I would always code a phone call with a patient. Just need to make sure it’s at least 17 minutes to get to the cutoff for 30 minute psychotherapy session. Also, the crisis code does not require time, just a legit crisis which we do have from time to time and also includes coordinating care. I have had circumstances where 15 minutes of my time was billed under crisis code or times when I spent a couple of hours dealing with a crisis and billed the code and the hour add on.

 

[texanpsychdoc]

With acceptance of telehealth, I would always code a phone call with a patient. Just need to make sure it’s at least 17 minutes to get to the cutoff for 30 minute psychotherapy session. Also, the crisis code does not require time, just a legit crisis which we do have from time to time and also includes coordinating care. I have had circumstances where 15 minutes of my time was billed under crisis code or times when I spent a couple of hours dealing with a crisis and billed the code and the hour add on.

So, if you had a client call you when it wasn't for their typically scheduled session, and that call lasted like 17 minutes, you would bill the insurance for that? If so, how would you go about that? I have a provision in my informed consent that outlines that I charge $50 for calls that go over 15 minutes, and I bill it in 30 minute increments with a minimum of 30 minutes billed the first time once they go over 15 minutes. This is mostly to deter people from being a chatty Kathy and wasting my time.

 

[WisNeuro]

Also, to add further context surrounding my initial question about coding the 96116 for PHQ and GAD is because at a former VA I worked at in the pain clinic, our initial eval to the clinic usually consisted of the PHQ, GAD, ACES, and usually a few pain related measures. In the end, my supervisor told me I should code 96116 in addition to 90791 for those encounters, even when the actual measures themselves never took 30 minutes. I would do the interview plus go through those measures probably within in 50 minute time period.

Then your supervisor was essentially committing fraud.

 

[texanpsychdoc]

Then your supervisor was essentially committing fraud.

Sounds like it. I was their trainee.

 

[texanpsychdoc]

You use 96127 for the PHQ9 or GAD7. It is a time based CPT code, that allows reimbursement for the minimal time for documenation.

It can not be an add on for 90791.

It can be an add on for EACH psychotherapy CPT codes. That's a 5% increase in revenue. Some insurers allow you to bill twice, once for PHQ9, once for GAD7, but they reject it initially, and then they want to see the time documented on appeal. Best to just do one.

Good to know. It's interesting they may only allow it once as for measurement based care, I tend to administer baseline measures, then a midpoint, and then one at termination. So...I guess I wouldn't be able to get reimbursed for the additional two times if I billed them.

 

[summerbabe]

This is good to know. What would be the circumstance where the 90785 would apply? How would one define and operationalize "interactive complexity?"

When I worked with stroke patients during a postdoc rotation, I would always use this code since we would rely on a variety of communication methods that go beyond standard delivery (notepad/whiteboard, stroke specific visual tools, lots of patience and troubleshooting, etc).

Currently, I almost never use this for my outpatient, adult caseload and if I do, it's almost always a one-off/unique situation where somebody was prominently dysregulated in ways that especially disrupted the session and required heavier degrees of intervention/effort on my part (versus people who present as naturally anxious, won't shut up, etc).

 

[PsyDr]

Good to know. It's interesting they may only allow it once as for measurement based care, I tend to administer baseline measures, then a midpoint, and then one at termination. So...I guess I wouldn't be able to get reimbursed for the additional two times if I billed them.

Ignore that. I am wrong because I use different billing codes. You can't use 96127 and 90832.

 

[Sanman]

Sounds like it. I was their trainee.

The only circumstances I could see justifying 96116 and 90791 would be in geriatric patients where you are called to assess a mood disorder and may need to screen with mmse, RBANS, etc to rule out cognitive impairment. Two different assessments 90791 to assess depression and neurobehavioral status to rule out MCI and assess fitness for psychotherapy. However, that would likely be a 90 min eval.

 

[texanpsychdoc]

Ignore that. I am wrong because I use different billing codes. You can't use 96127 and 90832.

Well, after you mentioned that, I went to Google it and found this: CPT Code 96127: Behavioral Assessment Billing Guide [+2023 Reimbursement Rates]

It appears that this code is fine to use as long as you are administering measures of "brief emotional/behavioral assessment."

Typically, for my initial evals in private practice I have folks complete a PHQ9, GAD7, and MDQ. It may be possible that I can seek reimbursement for these, right?

 

[PsyDr]

Well, after you mentioned that, I went to Google it and found this: CPT Code 96127: Behavioral Assessment Billing Guide [+2023 Reimbursement Rates]

It appears that this code is fine to use as long as you are administering measures of "brief emotional/behavioral assessment."

Typically, for my initial evals in private practice I have folks complete a PHQ9, GAD7, and MDQ. It may be possible that I can seek reimbursement for these, right?

You can use it with E/M codes, but apparently you cannot 96127 for psychotherapy or psych diagnostic evals.

There are medical biller and coder message boards. They are a good source of information

 

[smalltownpsych]

So, if you had a client call you when it wasn't for their typically scheduled session, and that call lasted like 17 minutes, you would bill the insurance for that? If so, how would you go about that? I have a provision in my informed consent that outlines that I charge $50 for calls that go over 15 minutes, and I bill it in 30 minute increments with a minimum of 30 minutes billed the first time once they go over 15 minutes. This is mostly to deter people from being a chatty Kathy and wasting my time.

In the post-Covid telehealth era, I bill it as a therapy session. I always thought that talking to patients on the phone for anything other than brief checkin or reschedule type stuff should have counted as therapy because it is and my understanding is that now we can bill it. What is funny is that now that I am all cash pay I am less likely to feel the need to charge for that type of contact.

 

[texanpsychdoc]

In the post-Covid telehealth era, I bill it as a therapy session. I always thought that talking to patients on the phone for anything other than brief checkin or reschedule type stuff should have counted as therapy because it is and my understanding is that now we can bill it. What is funny is that now that I am all cash pay I am less likely to feel the need to charge for that type of contact.

would you collect a co-pay from them? I am just trying to figure out how I would go about doing that. Let's say I have a patient call me and we end up talking of like 20 minutes. At the end of our call, do I say "oh btw, let me go ahead and charge you a $30 co-pay for today since we spent 20 minutes on the phone that way I can bill your insurance."

 

[PsyDr]

would you collect a co-pay from them? I am just trying to figure out how I would go about doing that. Let's say I have a patient call me and we end up talking of like 20 minutes. At the end of our call, do I say "oh btw, let me go ahead and charge you a $30 co-pay for today since we spent 20 minutes on the phone that way I can bill your insurance."

That’s a silly way of saying, “I am contractually obligated to get a copay for my professional services, that are based upon many years of hard earned education”.

Self respect is a thing. They are not calling you to shoot the breeze. You cannot bring up things you like to talk about. They are calling for your professional services. Attorneys have no problem charging for a 15 minute call. You should have the same.

If you don’t charge, they will call, get free services, and then no show for their paid appointments.

This took me a while to learn. I’d prefer if you learn from my mistakes and do better .

 

[texanpsychdoc]

That’s a silly way of saying, “I am contractually obligated to get a copay for my professional services, that are based upon many years of hard earned education”.

Self respect is a thing.

No, I get it, trust me, but I am trying to figure out a way of delivering that message to a patient who calls me out of the blue and we spend 20 minutes (or more) on an unscheduled call. How would you broach that conversation?

 

[medium rare]

Just tell the patient at the beginning of the conversation you provide a 5 - 10 minute phone call (whatever you allow if any) free of charge but if the conversation surpasses that, they will be charged for your time.

 

[PsyDr]

No, I get it, trust me, but I am trying to figure out a way of delivering that message to a patient who calls me out of the blue and we spend 20 minutes (or more) on an unscheduled call. How would you broach that conversation?

I edited.

The psychiatrists typically say, “sounds important. I can’t answer that question in this format. Schedule an appointment”. That’s not a bad answer.

If you can’t do that, answer, send the bill, let patients figure it out. It’s not bad boundaries. if they ask, remind them that this is a professional service, and that you expect treatment to eventually result in zero contact. In the meantime, if they want to spend the money, and you want to be available like that, it’s okay, until you pass reasonable boundaries.

If they resist, tell them “This is a professional service. While I care for you, your insurance require me to see you in person, and charge for that service. If that’s surprising, we might need to process this in session.”


Don’t be that psychologist that treated that guy from the Monkees, and live with your patient.

 

[Sanman]

No, I get it, trust me, but I am trying to figure out a way of delivering that message to a patient who calls me out of the blue and we spend 20 minutes (or more) on an unscheduled call. How would you broach that conversation?

Put it in your contract, discuss it with them during the first session, charge the copay the next time they come in, bill them by mail, or keep a credit card on file. Or, just don't pick up the phone.

 

[texanpsychdoc]

Good ideas. I just put it in my informed consent in two sections. One section that outlines our policy with appointments I outline that any phone calls that go beyond 15 minutes will result in the patient being charged; either via our private pay rate or via the contracted rate we have with their insurance. The second section I speak about it is in the Fees section that outlines that private pay clients will be charged $50 for any phone call that goes over 15 minutes, and is billed in 30 minute increments with a minimum of 30 minutes allocated (even if it doesn't take 30 minutes), then I outline that if a patient has insurance, we will bill their insurance per the contracted rate for services rendered by our practice, and we will charge them the appropriate co-pay or co-insurance per their insurance's policy.