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Hi, Kathy. In my private practice, my ongoing sessions are all 55 minutes and, since I do therapy in addition to E/M services, I code 99213,4,or 5 based on the complexity, etc. criteria and then add my psychotherapy component based on time, such as 90833, etc. Most sessions result in a 99213 plus 90833 coding. In researching my decision whether to go with the timed codes I reviewed the CPT manual's definition of "counseling and coordination of care" and found it lacking as a description of my usual sessions. However, I have used the 99 codes based on time for a couple of patients where medication issues are at the forefront and the situations are relatively acute, so "counseling and coordination of care" is appropos. I would definitely recommend taking a look at that definition and see if it truly applies. Reimbursement for 99215 has been about the same as formerly paid for 90807. The response to billing using E/M plus psychotherapy codes has remained about the same as before the code change. 99213 pays about 60% of the total reimbursement; the psychotherapy about 40%. And that is the approximate breakdown of my charge for a 99213/90833 session. I am much more comfortable with the idea that my documentation always meets at least the 99213 complexity criteria and often higher (215, 216). Either way, I feel confident of the documentation, should I have to submit it to support my choice of code. I'm using the Valant templates and find them very adequate to the task. As for confidentiality should I be required to share them, the templates are generically "medical" enough that anyone reading them would find little of interest regarding the content of our discussions. In other words, they're incredibly boring to read but quick and to the point when writing them. Hope this helps a little. Feel free to follow up by phone or email. We should have lunch! ------------------------------------------- ----------------------------------------- Kathleen Sheridan, PMHNP Portland OR (503) 360-6303 www.kathleensheridan.com ----------------------------------------- -------------------------------------------
Show Original Message
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Original Message:
Sent: 04-09-2013 14:33
From: Kathleen Kelley
Subject: NEW CPT codes and documentation
After much deliberation, I decided the E&M codes with more than 50% counseling/care coordination were the best fit for most of my visits. I have been using 99214 for my 25minute visits, and 99215 for 40-50 minute visits, which make up the bulk of my practice, without any problems in reimbursement. But in the past week I have had several requests for visits records from clients who have Providence Health Insurance, with Mental Health managed by UBH. I am not contracted with providence or UBH, but my clients cannot afford to pay their bill without insurance, so I am in the unenviable position of having to send my client's confidential records to an insurance company (they consent to this on the billing consent form, but I have never been asked for them before), stick them with a bill they can't afford, or eat the loss and find them other care.
I researched this issue on line, and apparently the 99214 and 99215 codes are triggering audits in many parts of the country. There is no way to for the insurance company to discern from the billing whether the code is based on counseling and coordination of care or complexity, or even whether it is a primary care vs. mental health visit. So, while I await a response to the notes I have sent for clients who request this, I am rethinking whether this is the best way to use the new codes. Previously I was using mostly 90805, 90807, and 90809, and never had any difficulty.
These are all patients with serious mental health issues, with whom I have a longstanding relationship. I feel like I am between a rock and a hard place.
Has anyone else had this experience? Any suggestions or words to the wise about dealing with the records requests?
Thanks,
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Kathleen Kelley, PMHNP
Lake Oswego OR
503-830-3215
kkelleyfaegre@earthlink.net
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Original Message:
Sent: 01-20-2013 09:52
From: Cheryl Waskiewicz
Subject: NEW CPT codes and documentation
Yes, in the attachments, find 2 notes I am test-driving.
The first--for E/M based on time and >50% providing counseling and/or coordination of care-- is authored by Seth P. Stein, copyrighted 2007; when I googled his name I learned he is an attorney for the New York Psychiatric Assoc.
The second--for E/M + Psychotherapy--is one I composed based on my listening to the webinars offered by APNA, AACAP, and the Natl Council, to whom I am very grateful for all efforts to assist us. I wanted a one-page note that incorporates all requirements, with prompts imbedded to guide my thinking and arrive at the right CPT coding. I welcome comments/critique.
With these 2 notes and the algorithms provided by AACAP, I am feeling like I'm beginning to master this learning curve.
My best to all,
Cheryl Waskiewicz, APRN
ROS__
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Cheryl Waskiewicz
Orange CT
(203) 988-7895 (home)
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Original Message:
Sent: 01-19-2013 13:41
From: Charlene Milkey
Subject: NEW CPT codes and documentation
Has anyone found a documentation form that is sufficient to meet the new CPT requirements? Thanks Charlene Milkey
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Charlene Milkey
family psychiatric nurse practitioner
Stamford CT
(203) 305-5165 (home)
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Charlene W. Milkey
PMHNP-BC
Stamford, Ct
203-305-5165
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