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I was curious, can psychologists bill for the CPT code 99205? Or is this strictly for physicians?
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?
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?
...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.Are you saying you'd bill both a 90191 and a 96116?
That would not be appropriate billing as both of those screens would fall under the 90791.
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 would take that long or even count for 96116.
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....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.
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.
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.
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.
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.
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.
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.
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).This is good to know. What would be the circumstance where the 90785 would apply? How would one define and operationalize "interactive complexity?"
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.
Sounds like it. I was their trainee.
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?
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.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.
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”.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.
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?
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?