Frequency of appointments

[jbomba]

Is it reasonable to see a patient monthly and bill a 99214 + 90833? I have patients with two diagnoses, on meds, who want to come back to see me once a month for a quick med check in and the rest of the time largely spent with therapy. Curious if this is kosher or if I need to start spacing these visits out more as to not run into problems with insurance.

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[Shikima]

Keep going monthly. Insurance will let you know. I have many I see monthly for years.

 

[rjs2131]

Don't see why this would be an issue - I have several patients like this. Of course, usually if we're needing to meet monthly things aren't 100% stable and there is room for growth (this does fluctuate with time). I see all of my patients q1-3 months generally and they are almost all 99214 + 90833.

 

[FlowRate]

I'd imagine there are some people billing 99214+90835 weekly, or do insurers push back more on the E/M when it's that frequent without actual changes in the medication plan?

 

[annoyedpsychiatrist]

i have some people with diagnosis such as BPD who i see monthly, we meet as a check in sort of thing. I do this in some of my younger patients with BPD who have a lot of potential but really struggle with emotional regulation, making poor choices, etc.

 

[clozareal]

I would not do anything pre-emptively to make insurances happy other than timely and accurate documentation/coding. Keep seeing that patient monthly until they send you something about medical necessity, then appeal it if they do. Keep billing for 99214 and 90833.

 

[calvnandhobbs68]

Yeah I have people I've seen monthly for a while I bill 99214 + 90833 and don't have any issue.

 

[jbomba]

And perhaps I should clarify this; these are patients I'm seeing who are stable on meds but are largely coming for therapy. No med changes made for many months.

 

[clozareal]

This is why I hate insurance. You're influenced to do less based on the financial pressures of insurance rather than what would be best for the patient.

 

[Stagg737]

And perhaps I should clarify this; these are patients I'm seeing who are stable on meds but are largely coming for therapy. No med changes made for many months.

Do you discuss meds at all? If so, you can bill the 99214. Could be as simple as "Do you feel like your meds are still helpful? Any problems or side effects?" If you actually do what's required (which isn't much) and document appropriately it shouldn't be an issue.

 

[jbomba]

Do you discuss meds at all? If so, you can bill the 99214. Could be as simple as "Do you feel like your meds are still helpful? Any problems or side effects?" If you actually do what's required (which isn't much) and document appropriately it shouldn't be an issue.

Always ask about meds. Probably spend 3-4 minutes about meds unless there's an issue.

 

[forchinet121]

Is it reasonable to see a patient monthly and bill a 99214 + 90833? I have patients with two diagnoses, on meds, who want to come back to see me once a month for a quick med check in and the rest of the time largely spent with therapy. Curious if this is kosher or if I need to start spacing these visits out more as to not run into problems with insurance.

This is extremely standard

 

[allantois]

Therapists see patients q1-2 weeks for years..

 

[jbomba]

Therapists see patients q1-2 weeks for years..

I get the therapy part makes sense. It's moreso would billing for med mgmt qmonthly when things are stable be kosher...

 

[Stagg737]

Always ask about meds. Probably spend 3-4 minutes about meds unless there's an issue.

Then you're fine.

I get the therapy part makes sense. It's moreso would billing for med mgmt qmonthly when things are stable be kosher...

Yes. If you're doing psychotherapy for a psychiatric condition which you are also prescribing meds and thinking about potential changes vs continuation, then you're doing med management.