Quick outpatient CPT billing question

[zen76]

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For all the private practice attendings,

I'm starting up a small part time private practice, med management with occasional consults or second opinions. However, I plan on doing some supportive psychotherapy, CBT "elements" along with EMDR and mindfulness based exercises where appropriate, I have EMDR basic certification and participated in an MBSR program and will probably take additional training in the next five years.

Mine will be a cash only practice, however I will provide a bill with Dx and CPT codes for patients to turn in to get reimbursed for an out of network provider for their insurance company if they so choose.

I would like to maximize their reimbursement, and would like to provide the 90805 code for therapy and med management, providing a minimum of 30 minute visits, incorporating psychotherapy elements, but not a full session, given my basic competency, but lack of more comprehensive training I don't feel justifies calling myself a psychotherapist. However, I feel it's more therapeutic than the usual 15 minute med management, "No SI, no side effects, keep going and don't let the door hit your ass on the way out" mill plan of treatment. That being said, most of my referral base are psychologists specializing in CBT or psychodynamic psychotherapy. Out of professional courtesy, I don't want to mess with their reimbursement, and am worried about insurance not allowing claims with their psychologist if I am giving them a 90805 code, and perhaps should use 90862 instead for pure med management.

Thoughts one way or the other, 90805 vs. 90862 given this context.

Thanks,
zen76

 

[OldPsychDoc]

I'm in "corporate private practice" and I have found that some payors do raise a stink if you bill a 90805 on a patient they are currently reimbursing for therapy with a different prescriber. You pretty much just have to know which insurers have that policy, and maybe bill the 90862 for those patients--UNLESS, at using 25-30 minutes and documenting the >50% C&C, you can bill a 99214 instead? (Our coding folks have told us that as long as we're inserting that magic script at the end, OR documenting a medical ROS for complexity--we've met the requirements.)
I find that most of my visits in which I address any co-morbities gets me there. I usually only bill 90805 when the majority of the visit has been "therapeutic" and I know they aren't seeing another "real" therapist.

This is why I love working for a multi-specialty corporate practice...

 

[sunlioness]

I only ran into a problem with that when they saw their therapist and me on the same day. Otherwise, my 90805s didn't seem to present a problem. And apparently, I was practicing in the same city as you (judging by your location). But I still second OPD's advice. It's worth checking into.

 

[zen76]

Thank you OPD, I hadn't even thought of that code, much appreciated.

zen76

 

[zen76]

...and you as well sunlioness.

zen76