Examples of documentation for psychotherapy add on?

[rjs2131]

---

Members don't see this ad.

" the expectation would be documentation of the start and stop times or total time of the psychotherapy with an E/M service and documentation of the start and stop times or total time devoted to psychotherapy."

I am a bit confused by this. Are they saying that for 90833 you can add time spent on psychotherapy woven into E/M conversations with time spent on purely psychotherapy?

Realistically, most will do the "weaving" of psychotherapy along with medical decision making. I always put in a start and stop time (usually the first 16 min of the visit) purely to satisfy this requirement and avoid someone later on scrutinizing my notes and telling me there isn't a way to tell if I did 16 min of therapy or not. Otherwise, I'd have to put in "3:00-3:05, 3:12-3:17, 3:24-3:30" or something ridiculous like this to highlight the times I spent doing therapy. That probably wouldn't even be accurate.

 

[calvnandhobbs68]

Realistically, most will do the "weaving" of psychotherapy along with medical decision making. I always put in a start and stop time (usually the first 16 min of the visit) purely to satisfy this requirement and avoid someone later on scrutinizing my notes and telling me there isn't a way to tell if I did 16 min of therapy or not. Otherwise, I'd have to put in "3:00-3:05, 3:12-3:17, 3:24-3:30" or something ridiculous like this to highlight the times I spent doing therapy. That probably wouldn't even be accurate.

Yep i do that because insurances require it too now however stupid it is. So I also put specific "start" and "end" times because I know people who have gotten burned for just putting down 17 minutes or something.

 

[Psychferlyfe3000]

Several have stated (here and in other forums) that they have been audited and that's not been sufficient. It may depend on insurance company, but at least some want modality of therapy, what was addressed, and patient's progress. Some also want start and stop times for therapy (not just total time) even though it's meant to be a service woven into the rest of the visit.

Do you know where the posts are that the folks have been audited posted?