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Lcsw e&m?!?!

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Chrismander

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Just wanted to share (& vent) the chaos that the new CPT changes are bringing to my practice. I'm employed by a large multispecialty group. Besides having to adapt the new E&M coding myself, here's the fun drama around here:

Our coding department along with the (non physician) head of the behavioral health clinic decided on their own that it would be appropriate (and essentially mandated) for our LCSW's and PhD's to bill E&M "up to level 3", since any higher would require vitals be taken--and that would be overstepping their professional bounds I guess. Plus they'd bill a psychotherapy code on top of all that.

I walked into our noon meeting to see a dozen LCSW's poring over the E&M coding grid, furiously trying to figure out what medical ROS questions they could reasonably ask, that would count for a level 3.

So besides being a huge crock of **** foisted upon our unsuspecting LCSW's, that our coding department should have known better about (which now raises my own suspicions about anything I've been told by them about MY OWN transition to E&M coding)--besides all that, they were told that because of the new E&M they're all going to be moved to RVU production and expected to bill straight Level 3's to maintain their current salaries...

Unbelievable. :nono:

Any other crazy stories from the world of E&M implementation?
 

Therapist4Chnge

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RVU "projections"/"standards" never seem to be realistic. I am very thankful I got out of that rat race.

As for E&M codes...a provider can basically submit a bill for whatever, though that doesn't mean it will actually get paid. Have providers at your hospital actually been paid for E&M codes they have submitted?
 

billypilgrim37

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As for E&M codes...a provider can basically submit a bill for whatever, though that doesn't mean it will actually get paid. Have providers at your hospital actually been paid for E&M codes they have submitted?

My understanding from our local APA/CPT guru is that LCSWs would not get reimbursed for E/M services. APRNs can (at a level 1--not sure if above that), but not LCSW. Even prescribing psychologists are getting a new non-E/M code for their services and will not be reimbursed for E/M. Almost entirely sure LCSWs will have to keep doing the standard time based psychotherapy codes, not the E/M+psychotherapy codes, no matter what they document.
 

Chrismander

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My understanding from our local APA/CPT guru is that LCSWs would not get reimbursed for E/M services. APRNs can (at a level 1--not sure if above that), but not LCSW. Even prescribing psychologists are getting a new non-E/M code for their services and will not be reimbursed for E/M. Almost entirely sure LCSWs will have to keep doing the standard time based psychotherapy codes, not the E/M+psychotherapy codes, no matter what they document.

Correct. Per medicare/CMS/common sense only MDs/DOs, PA's, and NP's can do E&M, not LCSW/PhD/etc. APRN (that's NP right?) should be able to do all levels of E&M too. Maybe have some sort of "supervision" requirement, who knows.

Prescribing Psychologists have to use 90863, cannot use E&M.
 
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