billing two patients in same psych session

[camedbill]

Can you bill therapy & med management for 2 siblings who were seen in same session? 
(ie. bill 99213 & 90836 for each patient who was seen together)
Thanks in advance for your help

[Merry]

Hope Linda sees this. She probably knows.

[Michele]

Was it a group/family session?  Or were they seen individually but just in the room together?  I have taken two of my children to the dr at the same time.  We all go in one exam room, but both are seen and insurance is billed for two individual visits.  Dr addresses one child's issue and then the other.  It is the same as two individual appointments it's just that because we are a family we are seen in the same exam room.  Is that the case in your question?

[PMRNC]

Can you bill therapy & med management for 2 siblings who were seen in same session?
(ie. bill 99213 & 90836 for each patient who was seen together)
Thanks in advance for your help

Are both patients? If so I'm thinking this isn't just a billinq question, I would think it a bit unethical to do E/M on 2 patients at same time? I think you should take a look at the family psychotherapy code's but I just can't see doing two E/M at once.. did you have to obtain an auth?

[Billing2]

Can you bill therapy & med management for 2 siblings who were seen in same session? 
(ie. bill 99213 & 90836 for each patient who was seen together)
Thanks in advance for your help

You can if your provider has good documentation showing each one had there  E/M code time and then 90836. We have a parent come in like this, we book the provider for one hour. Sometimes it's much easier then the parent coming two different times, or leaving one kid in the waiting room. Then the office staff become babysitters.

You would not bill a 90847 family therapy because it's not family, just sharing the room and making it easier for the parent's and most of all the office staff.

[PMRNC]

You would not bill a 90847 family therapy because it's not family, just sharing the room and making it easier for the parent's and most of all the office staff.

I'm sorry but I disagree.. SHARING a room and making it easier is NOT ethical in regards to E/M and documentation.. Making it "easier" isn't the issue.. if the provider was to bill 2 E/M's they need to be seen for same documentation in same manner.. saving room and time? How does the insurance company save on that? Two patient's (same family or not makes no difference, if they are BOTH patient's, they should be seen and billed their own E/M in their own face to face setting).   I can see how a provider might get away with this since "time" is not documented on the claim. I do not see this as ethical at all.

[Michele]

We do this at our pediatrician all the time.  I never saw it as unethical.  They do it for my sake not theirs.  I bring in two kids, by myself, they both have appointments, and I am the adult that the provider speaks to.  They do two completely separate face to face appointments, but they are in the same room.  Is that different then me going to one kids appointment bringing the other with me?  We are all still in the room. 

Not trying to argue, I just never saw anything wrong with this.  It doesn't happen often, but it does happen.  Maybe because I have so many darn kids I take to the same dr!  As long as both had separate appointments, the dr addressed them completely separate as if the other wasn't even present, and documented such.  They billed according to the complexity of each appointment individually.  I guess they could have made me leave the exam room and enter another one with the second child.

I want to make sure I'm not putting our dr in a bad position!   

[PMRNC]

I too do pediatrics.. and yes I know it's done exactly way you said.. same room but discussions are limited and separate.. mental health is completely different!!! There are NEVER identical diagnosis and documentation for 2 siblings with ONE provider and 2 e/m and psychotherapy sessions.. period. It is very different than seeing two kids in same family with ped's. MUCH different. IF the provider was to see each child they should be done so separately OR using the family codes. NOW yes I AGREE insurance companies PROBABLY would pay..but how are they being billed to distinguish BOTH children in same room, same session?  So of course they may have paid. If there is an ever an audit and notes were requested the provider would indeed be questioned!

[KarenH]

I bill both and I agree with Linda on this one. It's not a matter of convenience for the patient or patient's parents in MH this would never hold up to an audit.

[Michele]

I guess I wasn't thinking MH, just in general.  And also thinking as a parent, not a biller.