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Hello Mary - Yes, Medicare is paying more for 99215 vs 90792 ( I miss typed but that was my intention to note in my first few sentences). Payments by third party payors are always based on 'reasonable and customary' which is defined and dirrerentiated not only by region nationally (rates in Florida are potentially different than Kansas), but also locally (I get reinbursed less practicing in New Haven County than folks practicing in Fairfield County - local differences). Contracts with third party payors are following the trends I outlined in my last post - again, why I have chosen to bill the 90792 - I don't rountinely see Medicare so I am 'out of network' for those few folks in my practice. Anti-trust laws, which I just reviewed with several of your friends at our local professional organization, prohibit me from sharing these contract specifics with you or anyone. I am meeting, with a few other invested parties, with the AG here in CT in a few weeks and have spent a good deal of time with several MDs from various specialties to better educate myself for this meeting and learned about this anti-trust issue from them. Thankfully, as well, as I am not interested in engaging in a precarious relationship with these institutions....at least not over violating aspects of my contact that I was unaware of. ------------------------------------------- ----------------------------------------- Danielle Morgan,MSN, ANP, NS, Family PMHNP, APRN-BC Danielle Morgan, LLC 846 State Street New Haven, CT 06511 (203) 772-1077 danielle.morgan@aya.yale.edu ----------------------------------------- -------------------------------------------
Show Original Message
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Original Message:
Sent: 02-06-2013 20:30
From: Mary Moller
Subject: billing sheets
Danielle, your comments are most interesting. We are hearing from all over the country that the payments are all over the place based on region and carrier. this is good news for Connecticut. I I printed out the Medicare 2013 payment and they are paying $120 for a 99205 and only $80 for 90792. f you could somehow send me a copy of what you have you received it would be most helpful! Thank you.
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Mary Moller
Associate Professor, Specialty Director-Psychiatric Nursing
Yale University School of Nursing
New Haven CT
(203) 389-4277 (home)
(203) 737-1791
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Original Message:
Sent: 02-05-2013 05:32
From: Danielle Morgan
Subject: billing sheets
Hello everyone:
I have just reviewed all the fee schedules I have from the many contract with third party payors I have received and all the 90792s at all the payors are reimbursing at a higher rate than the 99205. Medicare will pay a higher rate for 99205 vs 99205, I'm told but have not seen this in black and white yet. All the learning forums I participated in in December encouraged us to use the 90792 for several reasons: it will pay better, it is less rigorous in assessment and documentation demand than the E&M 60 min eval code, and (as the CPC from Yale who did a great presentation explaining) what we all do in our initial eval is adequately accounted for by the 90792 - seems like a no-brainer to me. I also wonder if the 99205 may need prior auth with some, as it falls into that 60 min zone, which often carries prior auth with it.
In the 45 min - 60 min that I spend with a new pt, I rarely can collect all the data nec to bill a 99205, and if it's paying less, I choose to meet the 90792 rigors. The differences are the following:
90792 = requires 'standard' H&P documentation similar to 90801 (cc, HPI, past psych/med hx, FH, SH, MSE, assessment, and recommendations
99205 - as with all E&M codes - require more extensive ROS (not needed in 90792), usually requires vital signs, and can be billed based on time if greater than 50% is spent in counseling and coordination of care.
The best training I attended, presented by a Yale MD who was snet down to DC and worked for years making this billing option available to us stated in summation that typically think about using the 99205 not as a routine code (unless you really can document all those rigors) but when you meet that rare pt in outpt practice who "blows up your morning", suicidal, homicidal, needing hospitalization and has a demanding spouse you need to work with. Great guideline that I have been using in my practice: from a fiscal, clinical utility, and pragmatic point of view it works for me. Follow up visits, if I prescribe meds, are then captured with my E7M coding as well as therapy add ons, as appropriate.
Hope that helps...Danielle
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Danielle Morgan, MSN, ANP, CNS, Family PMHNP, APRN-BC
Danielle Morgan, LLC
846 State Street
New Haven, CT 06511
(203) 772-1077
danielle.morgan@aya.yale.edu
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Original Message:
Sent: 02-04-2013 08:08
From: cathy paluzzi
Subject: billing sheets
Can someone help me to understand the difference between a 90792 and 99205 for a new patient? I have been only billing a 90792.
Thanks!
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cathy paluzzi
aprnbc
waltham MA
(781) 330-6926 (home)
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