Medical Billing Forum
Coding => Coding => : bguldi August 02, 2015, 09:58:42 PM
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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.
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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