Documentation for Billing Encounter for an Appointment that provides service of Psychiatric Medication Management and Psychotherapy Add on Code?

[prominence]

When billing an encounter for both psychiatric medication management and psychotherapy, to what extent do psychiatrists document the therapy portion of the session?

I am transitioning from a position where I solely had been doing intake evaluations.

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[jbomba]

I document length of time, modality of therapy, goals of therapy, patients receptiveness/engagement to the intervention.

 

[Attending1985]

When billing an encounter for both psychiatric medication management and psychotherapy, to what extent do psychiatrists document the therapy portion of the session?

I am transitioning from a position where I solely had been doing intake evaluations.

my coder tells me time spent in psychotherapy, modality, a summary of what was covered, goals, patient response and progress
I’m also required to spend 30 minutes in therapy to bill a 90833 so appointment has to be about 45 minutes

 

[lobstar]

1) Total minutes: 16-37 is 90833 and 38-52 is 90836. So that's the crux of billing.
2) 1-2 sentences on mode of therapy and specific thing talked about/worked on.
3) "Goals are progressing" or something more specific if you have the motivation.

 

[Bartelby]

Agreed, 16 minutes of therapy separate from E&M is the bar to clear. I keep the description of therapy succinct, something like "+18 minutes supportive psychotherapy focused on behavioral activation and processing interpersonal stressors." I have not yet had any pushback.

 

[jbomba]

my coder tells me time spent in psychotherapy, modality, a summary of what was covered, goals, patient response and progress
I’m also required to spend 30 minutes in therapy to bill a 90833 so appointment has to be about 45 minutes

Where are you getting those times from? 90833 is only 16 minutes minimum. And there is no set amount of time that e&m has to be done for in this scenario.

 

[calvnandhobbs68]

Some insurances want start/stop times for the therapy portion so I just do it for everyone, my beginning blurb looks like this:

Time: X minutes of face to face time
Start time:
Stop time:

 

[calvinhobbes]

Where are you getting those times from? 90833 is only 16 minutes minimum. And there is no set amount of time that e&m has to be done for in this scenario.

Agree

 

[Merovinge]

my coder tells me time spent in psychotherapy, modality, a summary of what was covered, goals, patient response and progress
I’m also required to spend 30 minutes in therapy to bill a 90833 so appointment has to be about 45 minutes

Definitely does not need to be 45 min. 30 minutes with 90833 is standard across the board. 16 min of psychotherapy and 14 minutes to go through the E&M. There are people who do 20 min and bill those codes where I feel 4 min for the E+M is really pushing it, but 30 minute appointments can/are routinely 99214+90833. This IS the unlock that allows psychiatry to spend longer with patients and still make good money. It's not as good as my partner seeing 6 patients an hour at 99214s, but it sure beats just 2x 99214.

 

[jbomba]

On the topic of private practice versus joining a group, I met with a very large group with about 60 psychiatrists. They have what I would considered very high reimbursements. Standard 214 and 833 reimbursing 300, so 600/hr. Group takes 30%. Collection rate is 99.6%.

So I'd be earning ~400/hr after their cut. Full office staff, office availability, contracted with two dozens insurances so you apparently fill up very quickly. Physician owned. Part-time okay, you do all of your own scheduling/time off, no push to see a certain number of patients. This is a no brainer right?

 

[Merovinge]

On the topic of private practice versus joining a group, I met with a very large group with about 60 psychiatrists. They have what I would considered very high reimbursements. Standard 214 and 833 reimbursing 300, so 600/hr. Group takes 30%. Collection rate is 99.6%.

So I'd be earning ~400/hr after their cut. Full office staff, office availability, contracted with two dozens insurances so you apparently fill up very quickly. Physician owned. Part-time okay, you do all of your own scheduling/time off, no push to see a certain number of patients. This is a no brainer right?

I'd just make sure you talk to a younger doc or 2 at the practice to hear their experience. Biggest concerns I would have would be buyout by PE looming or malignancy in the higher ups looking to extract something from you. That collection rate is absurdly good, I am curious how they can have that much absolute efficacy.

 

[Cath Up]

On the topic of private practice versus joining a group, I met with a very large group with about 60 psychiatrists. They have what I would considered very high reimbursements. Standard 214 and 833 reimbursing 300, so 600/hr. Group takes 30%. Collection rate is 99.6%.

So I'd be earning ~400/hr after their cut. Full office staff, office availability, contracted with two dozens insurances so you apparently fill up very quickly. Physician owned. Part-time okay, you do all of your own scheduling/time off, no push to see a certain number of patients. This is a no brainer right?

They on the west coast? That’s phenomenal. Are they selective/open to new grads?

 

[Stagg737]

I'd just make sure you talk to a younger doc or 2 at the practice to hear their experience. Biggest concerns I would have would be buyout by PE looming or malignancy in the higher ups looking to extract something from you. That collection rate is absurdly good, I am curious how they can have that much absolute efficacy.

True, as long as there's not major red flags or strings sounds like a great deal. If this is really a group of 60 psychiatrists, they probably have a lot of bargaining power with insurance to get those rates. I'd imaging the owners are going to be less likely to sell to PE given they're probably raking in some big bucks without them even doing any clinical work themselves if they have any idea how to run a business, which it seems they do.

 

[MedMan80]

On the topic of private practice versus joining a group, I met with a very large group with about 60 psychiatrists. They have what I would considered very high reimbursements. Standard 214 and 833 reimbursing 300, so 600/hr. Group takes 30%. Collection rate is 99.6%.

So I'd be earning ~400/hr after their cut. Full office staff, office availability, contracted with two dozens insurances so you apparently fill up very quickly. Physician owned. Part-time okay, you do all of your own scheduling/time off, no push to see a certain number of patients. This is a no brainer right?

ya

 

[jbomba]

True, as long as there's not major red flags or strings sounds like a great deal. If this is really a group of 60 psychiatrists, they probably have a lot of bargaining power with insurance to get those rates. I'd imaging the owners are going to be less likely to sell to PE given they're probably raking in some big bucks without them even doing any clinical work themselves if they have any idea how to run a business, which it seems they do.

Company has been around better part of 2 decades. Seems like theyve got a stable machine going.

 

[splik]

Company has been around better part of 2 decades. Seems like theyve got a stable machine going.

Do they pay you a fixed rate for each CPT code regardless of insurance, or does it depend on the insurance? As there are often very different rates between insurance companies, there is no way every insurance they contract with is paying exactly or even approximately the same. The other thing to bear in mind is your compensation will be lower to start with as you'll have predominantly new patients but will get to that over time.

I'll give you an example. One of the groups near me was getting reimbursed about $335 for the 99214+90833 combo by one insurance. It's probably more now - this was 3 years ago. They take lots of insurances including medicare and this is one of the less common insurances. So if you were estimating your compensation based on this reimbursement it would be quite a bit lower. They also had issues w/ being on prepayment review with another insurance so a lot of people didn't get paid for a lot of claims for like a year which is untenable for a lot of people.

In addition to asking % claims collected it is also help to know average time to collection, the longest time to collection, and whether they have been any audits, prepayment reviews, or clawbacks.

In my consulting work I've found out that the different BCBS subsidiaries under elevance health are being more aggressive and this has been stressful and ruinous even for some group practices. Aetna has also been upping its game with denials, requests for records etc. UHC/optum is no worse than before and interestingly might have even softened down from excrutiating to just plain awful.

 

[jbomba]

Do they pay you a fixed rate for each CPT code regardless of insurance, or does it depend on the insurance? As there are often very different rates between insurance companies, there is no way every insurance they contract with is paying exactly or even approximately the same. The other thing to bear in mind is your compensation will be lower to start with as you'll have predominantly new patients but will get to that over time.

I'll give you an example. One of the groups near me was getting reimbursed about $335 for the 99214+90833 combo by one insurance. It's probably more now - this was 3 years ago. They take lots of insurances including medicare and this is one of the less common insurances. So if you were estimating your compensation based on this reimbursement it would be quite a bit lower. They also had issues w/ being on prepayment review with another insurance so a lot of people didn't get paid for a lot of claims for like a year which is untenable for a lot of people.

In addition to asking % claims collected it is also help to know average time to collection, the longest time to collection, and whether they have been any audits, prepayment reviews, or clawbacks.

In my consulting work I've found out that the different BCBS subsidiaries under elevance health are being more aggressive and this has been stressful and ruinous even for some group practices. Aetna has also been upping its game with denials, requests for records etc. UHC/optum is no worse than before and interestingly might have even softened down from excrutiating to just plain awful.

Thanks for the input. I will ask about clawbacks and audits. The insurances reimburse differently but the average amongst the docs works out to around 300 per follow up. I was told average time to collect is 30 days.