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CPT Coding Changes

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CPT Coding Changes sorted by thread
 
  Therapy notesSep 19, 2013 9:12 PMRomnee Auerbach
  RE:Therapy notesSep 20, 2013 4:51 AMBarbara Limandri
  RE:Therapy notesSep 20, 2013 8:37 AMMary Moller
  RE:Therapy notesSep 20, 2013 3:45 PMRomnee Auerbach
  RE:Therapy notes
Sep 22, 2013 10:00 AMMary Moller
  RE:Therapy notesSep 20, 2013 5:17 PMRomnee Auerbach
  RE:Therapy notesSep 20, 2013 7:08 PMKathleen Sheridan
  RE:Therapy notesSep 20, 2013 8:15 PMRomnee Auerbach
 

1.
Therapy notes
From: Romnee Auerbach
To: CPT Coding Changes
Posted: Sep 19, 2013 9:12 PM
Subject: Therapy notes
Message:
Hello,

Can someone clarify for me- hopefully once and for all-  ??

When adding on a therapy code such as 90833,36 or 38--- does therapy documentation have to be a separate page? or can we document vaguely (if reasonable and we choose to) on our progress note?

The separate page seems like more work.

Thanks,
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Romnee Auerbach ANP, PMHNP-BC
New Perspectives Center
Salem, OR 503-316-6770 (work)

OR-APNA Board Member
Portland, OR

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2.
RE:Therapy notes
From: Barbara Limandri
To: CPT Coding Changes
Posted: Sep 20, 2013 4:51 AM
Subject: RE:Therapy notes
Message:
Hi Romnee,
I can't promise this as the ultimate answer. What we do at Portland DBT Institute is incorporate into our progress note. We use EHR and have a template. Each note is a SOAP note with the Objective including: Mental Status Exam, Review of Systems (Constitutional: vital signs; Musculoskeletal: gait or AIMS; Neurological; and Other-usually GI or other assessment related to side effects of meds), and PHQ-9 (because depression is so often a comorbidity). This meets the requirements of the E & M for these codes. I will be glad to share our template. If you are using Practice Fusion, I can even share it directly with you through Practice Fusion.
Hope this helps.
Barbara

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Barbara J Limandri, PhD, APRN, BC
Professor & APRN
Linfield College School of Nursing
and Portland Dialectical Behavior Therapy Program
Portland Oregon 97210
503-413-8359
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3.
RE:Therapy notes
From: Mary Moller
To: CPT Coding Changes
Posted: Sep 20, 2013 8:37 AM
Subject: RE:Therapy notes
Message:
I always put them on the same page.  I do the E&M first and then under that make a note related to the 90833.Hope this helps!

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Mary Moller
Associate Professor, Specialty Director-Psychiatric Nursing
Yale University School of Nursing
New Haven CT
(203) 389-4277
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4.
RE:Therapy notes
From: Romnee Auerbach
To: CPT Coding Changes
Posted: Sep 20, 2013 3:45 PM
Subject: RE:Therapy notes
Message:
I appreciate the reply Mary. It helps a lot. I have had some insurance companies say the notes must be on a separate page. I prefer to have on one page- in a few occasions I have done a separate page if I thought the therapy aspect of the session was too confidential to include on a med note that could be released to someone I may not want it to be released to.

Thank you!

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Romnee Auerbach ANP, PMHNP-BC
New Perspectives Center
Salem, OR 503-316-6770 (work)

OR-APNA Board Member
Portland, OR

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5.
RE:Therapy notes
From: Mary Moller
To: CPT Coding Changes
Posted: Sep 22, 2013 10:00 AM
Subject: RE:Therapy notes
Attachment(s):
Message:
Dear Group,
This is an important discussion we are having.  What I always like to tell people is to make sure in your head you are differentiating between PROGRESS therapy notes and PROCESS private notes.  Your process notes are the details of where you  are in therapy and should never be referred to in your PROGRESS notes.  As long as they aren't mentioned in the chart they are NOT discoverable in a court of law.  They are your private notes and of course should be locked and hidden away.  They actually provide an incredible journal of your growth and development as well as the progress of the patients.  In the PROGRESS notes you can make a broad brush statement of the type of therapy, goals of the therapy, and patient progress to day.  Here is a section of a chapter I wrote on Billing and Coding for Kate Wheeler's new edition that should be out this fall:

It will be important to include narrative comments related to target symptoms; goals of therapy; method of monitoring outcomes; frequency of treatment; clinical records to support relevant medical history; results of diagnostic tests or procedures; prognosis or progress to date; and, estimated duration of treatment.  The types of psychotherapy recognized by CMS include psychodynamic, behavioral, and ego supportive. It is suggested to create a template that you can modify with changes that have occurred since the last session.  Medicare requirements for psychotherapy session documentation are included in Box 5.1.

Box 5.1 Medicare Requirements for Psychotherapy Sessions

  • Target symptoms
  • Goals of therapy
  • Method of monitoring outcomes
  • Frequency of treatment
  • Clinical records to support relevant medical history
  • Results of diagnostic tests or procedures
  • Prognosis or progress to date
  • Estimated duration of treatment.

Also, here's a great article written many years ago that I refer to:

Gutheil, T. (1980). Paranoia and progress notes: A guide to forensically informed psychiatric recordkeeping.  Hospital and Community Psychiatry, 31, 479-482.

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Mary Moller
Associate Professor, Specialty Director-Psychiatric Nursing
Yale University School of Nursing
New Haven CT
(203) 389-4277
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6.
RE:Therapy notes
From: Romnee Auerbach
To: CPT Coding Changes
Posted: Sep 20, 2013 5:17 PM
Subject: RE:Therapy notes
Message:
I would love to see examples, if people are willing, of how they incorporate therapy into their notes.

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Romnee Auerbach ANP, PMHNP-BC
New Perspectives Center
Salem, OR 503-316-6770 (work)

OR-APNA Board Member
Portland, OR

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7.
RE:Therapy notes
From: Kathleen Sheridan
To: CPT Coding Changes
Posted: Sep 20, 2013 7:08 PM
Subject: RE:Therapy notes
Message:
Hello Romnee.  Looking at the question another way, I see an increased opportunity for confidentiality in separating psychotherapy notes.  Notwithstanding an insurance company's particular requirements, there is good reason for separating detailed, typically handwritten, psychotherapy notes from your regular session notes.  Psychotherapy notes are not subject to federal laws regarding the patient's right to view them or to request that they be changed.  Unlike the note that documents the technicalities of the visit, such as HPI, Assessment, Diagnoses, Medications, Plan, etc. psychotherapy notes have been deemed the "temporary" notes of the therapist, existing solely for the purpose of reminding her or him what was discussed in therapy and are not considered legal notation for the purposes of sharing.  This would address your concerns about formally documenting sensitive information that is not directly germane to the plan of care, but is more useful in conducting the actual therapy.  More general statements can be included in the session documentation if needed.

When I am back in my office next week, I'll look for a copy of an excellent article on this topic and post the reference here.

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Kathleen Sheridan, PMHNP
Portland OR
(503) 360-6303
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8.
RE:Therapy notes
From: Romnee Auerbach
To: CPT Coding Changes
Posted: Sep 20, 2013 8:15 PM
Subject: RE:Therapy notes
Message:

Really good points Kathleen! I appreciate them.

Some of us are not good at remembering things very well so as to "pick up" where we left off--- although most of the time we can.-  I think the other thing I struggle with is the idea (my background as an ANP) of charting info so that my team members are also aware of the picture/story for continuity of care.  I recognize some people prefer to communicate these things by the telephone but then again- some of us (me) are more visual and need to see to remember.

But your points are well taken---- and the reminder is good....and I suppose that if I jotted down more notes on the side for myself, the notes would be ok unless subpoenaed.

Another reason I write a separate page (aside from psychiatrist saying this is recommended by APA too) is that many of the individuals I see do have therapists they see (but talk to me- imagine that :)  and I often think what comes out is important for the therapist to be aware of.  

Frankly, there is too much documentation already so any opportunity to lessen it- I'd be thrilled.  I would love to see your template!

Thanks!


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Romnee Auerbach ANP, PMHNP-BC
New Perspectives Center
Salem, OR 503-316-6770 (work)

OR-APNA Board Member
Portland, OR

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