Documentation requirements for psychotherapy add-on

[DD214_DOC]

How strict are these requirements, and what is necessary? I don't do this as much as I probably should and I haven't been able to find any good reference on what is actually necessary for documentation.

Also, does anyone understand the damned, "Interactive Complexity" code and what qualifies?

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[Shikima]

I'm not sure what "interactive complexity" means - the addons are time based. Your documentation must show when you start and stop the talk therapy portion and when you do meds.

 

[DD214_DOC]

I'm not sure what "interactive complexity" means - the addons are time based. Your documentation must show when you start and stop the talk therapy portion and when you do meds.

I set that piece up in my template already, but it's a bit arbitrary -- one usually flows from the other. What else is needed in the, "psychotherapy" segment besides start/stop time? This is what I made as part of my template:

Psychotherapy Note
Start: N/A
Stop: N/A
Total Psychotherapy Time: N/A
Current Clinical Status: N/A
Focus of Therapeutic Encounter: N/A
Intervention Type: N/A
DX: N/A
Plan: N/A

I think, "Current Clinical Status" was a summary or formulation of the case (basically the HPI) and the rest is self-explanatory.


I just learned that, for E/M codes, the DoD requires ALL 3 E/M elements for codes to count, not 2/3 elements -- so lots of downgrading here. Dumb.

 

[st2205]

Interactive complexity:

The 4 specific communication difficulties during the service (maladaptive communication among visit participants, interference from caregiver emotions or behavior, disclosure and discussion of a sentinel event, and language difficulties) represent significant complicating factors that increase the work of the primary psychiatric procedure.

https://www.aacap.org/App_Themes/AA...ractice/cpt/2013_CPT_module_November_2012.pdf

 

[wolfvgang22]

For 90833 therapy add on I just write in the HPI that "I spent x number of minutes in Brief Supportive Psychotherapy with the patient". It has to be from 16 to 37 minutes for that code to apply.

 

[Shikima]

For 90833 therapy add on I just write in the HPI that "I spent x number of minutes in Brief Supportive Psychotherapy with the patient". It has to be from 16 to 37 minutes for that code to apply.

Any problems from Audits for this?

 

[wolfvgang22]

Any problems from Audits for this?

No.

 

[wolfvgang22]

The VA does bill private insurance. I do have patients who have insurance or use medicaid and medicare. Not all my patients are 100% service connected for their mental illness, so they do still get billed. Also, I do see many spouses of veterans who do not qualify fo benefits or CHAMP- VA and insurance pays. My charts have been audited. It is true the VA doesn't worry quite as much about those veterans who have no non-VA insurance. They do still treat billing like a real thing, and additionally still track my wRVUs closely.
Other than that, I agree.

 

[digitlnoize]

If you are actually billing, most people don't care about start and stop times (which would be ridiculous anyway as the open secret is that there is NEVER a separately identifiable psychotherapy portion of a visit) but you should put how much time was spent providing psychotherapy for example "This was a 30 minute visit with E&M and 20 mins of supportive psychotherapy)" I will also add something about the techniques such as "provided empathic validation, praise, identifying and naming emotions, reflection" and leave at that, and that appears to suffice.

This is almost exactly what we do at my program. Time spent, then a little paragraph about the therapy portion seems to suffice. I always use "I provided reflective listening, reflection, and allowed them to express affect in therapy", which is a phrase our PhD psychologist gave me. Seems to work fine.

 

[Shikima]

though in fairness you work at the VA so it doesn't really matter since they're not really billing for any of this. I remember in residency the VA psychiatrists would frequently document support psychotherapy as something that was explicitly not psychotherapy for these purposes (for example discussing medication adherence, exploring pt's ambivalence/motivation to take medications is not supportive psychotherapy for these purposes and is counted as counseling as coordination of care) - but it doesn't matter in the VA system.

If you are actually billing, most people don't care about start and stop times (which would be ridiculous anyway as the open secret is that there is NEVER a separately identifiable psychotherapy portion of a visit) but you should put how much time was spent providing psychotherapy for example "This was a 30 minute visit with E&M and 20 mins of supportive psychotherapy)" I will also add something about the techniques such as "provided empathic validation, praise, identifying and naming emotions, reflection" and leave at that, and that appears to suffice.

You must put start and stop times when billing for Medicare/Medicaid services.