Medical Billing Forum

Coding => Coding => Topic started by: bguldi on August 02, 2015, 06:58:42 PM

Title: 99215 & 90838 (E&M of high complexity and psychotherapy 60 min)
Post by: bguldi on August 02, 2015, 06:58:42 PM
I am in a conundrum.  Many insurance companies such as Blue Cross Blue Shield, Aetna, etc will reimburse exactly the same amount for a 90836 (45 min psychotherapy) and a 90838 (60 min psychotherapy). With that being said our psychiatric nurse practitioner is seeing the patient for a total of 60 minutes for the session.  As of now she has been billing out as a 99214 & 90836.  Since psychotherapy is reported in conjunction (occurring at the same time as) with the E&M and the AMA states that if 50% of the time of the visit is spent in couciling it qualifies the said code wouldn't a 60 minute session then qualify as a 99215 (typically 40 minutes)?  If someone could give me clarification on that I would be grateful.

For more background we always have at least 3 diagnoses, at least three vitals checked, review of all systems, review of history, and 12 psych exam components in each session.
Title: Re: 99215 & 90838 (E&M of high complexity and psychotherapy 60 min)
Post by: rdmoore2003 on August 04, 2015, 02:16:47 PM
the psychotherapy code is defined by the minutes.   E/M codes is defined more by components.

99214-for established pt. requires two of the three components:
a) a detailed history
b) a detailed examination
c) medical decision making of moderate complexity

99215- for established pt. requires two of the three components:
a) a comprehensive history
b) a comprehensive examination
c) medical decision making of high complexity