Author Topic: PCP's treating their patients for depression and or anxiety  (Read 1447 times)

srcoder20

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I have a question regarding the above in my subject line. I went to my PCP just two days ago, and she knew I was a coder and explained to me she was having a major issue with her coder. The coder that works for her, has told her that she can NOT under any circumstances treat her patients for either depression or anxiety, that she has to send them to a mental health provider. I told her, honestly I have NEVER heard of that, but that didn't mean it wasn't true,( I didn't want to make her coder look bad) but I have called a couple of insurance companies and they have said no that isn't true, but, of course I haven't had a chance to call all the insurance company's, is there anybody else that has heard of this? Or is her coder somehow getting confused with something else.


Thank you so much!
Sherry

RichardP

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Re: PCP's treating their patients for depression and or anxiety
« Reply #1 on: June 07, 2013, 04:16:10 PM »
Diagnosis = depression; procedure = polyps removed from small intestine.  Paid or not?
Diagnosis = depression; procedure = repair of aortic aneurysm.  Paid or not?
Diagnosis = depression; procedure = Hepatitis A vaccine.  Paid or not?

We have gastroenterologists, cardiac specialists, endocrinologists, OB/Gyn, and Internal Medicine clients.  Those who present with anxiety or depression will get a battery of tests done to confirm or rule out certain biological causes.  Where appropriate, the patient is referred to appropriate specialists.

When billing, we often use an anxiety code, where appropriate, but usually as a supporting diagnosis.  Only rarely would we ever use an anxiety code as the primary diagnosis, unless the complaint had to do with a sleep disorder or something similar.  We do not get paid when we use a depression code as primary diagnosis, so our doctors never use a depression code.

Whether or not a doctor gets paid with an anxiety or depression diagnosis code depends on that doctor's Taxonomy Code.  Those doctors who are trained to deal primarily with emotional disorders would be more likely to get paid.  A gastroenterologist or cardiac specialist, not so much.  What procedure can a cardiologist do to support a depression diagnosis code?

PMRNC

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Re: PCP's treating their patients for depression and or anxiety
« Reply #2 on: June 07, 2013, 05:23:38 PM »
There are also state laws that if dispensing psychiatric meds that a psychiatrist be consulted (time period by state)   In NY if the PCP is managing medication he can do so but there has to be an ordering psychiatrist. Perhaps that is what is being referenced.   Example:  PCP sees patient who says.. I'm anxious.. PCP can dispense a script for a certain period but then to refill (again depending on state) patient has to see a psychiatrist.

 
Linda Walker
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francprz

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Re: PCP's treating their patients for depression and or anxiety
« Reply #3 on: June 19, 2013, 03:24:42 PM »
I bill for PCP's and bill code 96101 with psychological diag. codes primary for 96101 or mini mental,  not for the E&M for E&M I use medical codes with modifier 25, Some insur companies reimburse for PCP's and some do not because they fall under the behavior health benefits, and based on the scope of practice for the provider they pay them, but some require they be certified to provide those service.  When verifying benefits we always ask if prior authorization is required, and if based on the NPI of the provider will they pay them that type of service.  If it is not a benefit for my providers, and patients are coming in only for depression or anxiety, we will ask the provider to diagnosis "signs and symptoms, such as fatigue, shortness of breath, pain, etc. and the level of E&M is based on complexity, or counseling time, or integration of test.