Hi Robin,
I so understand your confusion. Welcome to the crowd. My APRN consultation group spent about 45 minutes yesterday discussing this topic. Let me share with you what we collectively decided.
1. Use 99205 code for initial visits for evaluations including medications. Note must include comprehensive history, comprehensive exam (for psych this means full MSE, psychosocial, risk assessment, substance use assessment & review of systems), medical decision making of high complexity (includes medications & drug interactions, PARQ conference, collaboration of care)
2. Avoid using 90792 for initial visits because it is usually reimbursed at a lower rate without compensating for the decision making complexity.
3. Use 90834 for psychotherapy alone for client only if appt does not exceed 50 minutes
4. Use 99214 (up to 25 min) or 99215 (up to 40 min) for medication follow up appts and include E/M reference to 4 systems in notes (usually constitutional-vital signs, musculoskeletal-gait & motor activity, MSE, and one other based on assessment for adverse effects). If you bill for 99213 it means moderate complexity for 15 min or less.
5. Avoid billing for 99212 and definitely not 99211 because these are for 10 minutes of low complexity that probably is not something the APRN will do. For example, give someone samples, take vs only, etc.
6. The psychotherapy only codes are usually straightforward so you probably can figure these out easily.
7. If the client yells at you or the family interfer with treatment, add on 90785 but know you will probably only be reimbursed around $4: )
I suggest you go to the web sites of the various insurance companies that you accept to get the local reimbursement rates. This helped considerably. I suspect the APNA conference will have something on both the CPT codes and the new DSM 5, therefore be on the web site in a few months but that is after you have probably lost lots of income from inaccurate billing. I know the APNA CE committee is working on online offerings soon as well.
Good luck.
Barbara
-------------------------------------------
-----------------------------------------
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
-----------------------------------------
-------------------------------------------
Show Original Message
-------------------------------------------
Original Message:
Sent: 02-17-2013 19:03
From: Robin Beckley
Subject: I am confused!
I watched the 2nd webinar and thought I understood the coding process then I saw the 3rd webinar and I am confused again! I was wondering if there is a person I can talk to personally or is there a seminar that I can attend in MO that can help me so I bill correctly?
-------------------------------------------
-----------------------------------------
Robin Beckley
Macon MO
(660) 651-6126 (home)
-----------------------------------------
-------------------------------------------