Coding using E&M vs. 908 codes in Psychiatry Coding and Billing Forum

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Coding using E&M vs. 908 codes

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TWNGRLS	Coding using E&M vs. 908 codes	Lead	[-]
Posts: 16 Apr 29 08 6:20 AM Reply Quote More My Recent Posts	Tags : None Hi, My provider ( a Ph.D. psychologist) came to me and asked me to look up the codes for patients with medical problems. I am assuming she means E&M codes (99 codes). I have never used E&M when billing for mental health because there has never been a need. However, she heard from someone that we can use E&M codes and that if the patient has a medical diagnosis that is a priority we can use that instead of the mental health diagnosis. She also said that the benefits would come from the medical benefits and may be paid better and may not have a cap. Can anyone help me with this? I know I have heard we are able to use the E&M codes, but I have never heard about them taking the money from the medical benefits and not the mental health benefits. I want to make sure that I am completely informed before I go to her and say this is what we need to do. Any help would be greatly appreciated. Tammy
Doo	Re: Coding using E&M vs. 908 codes	#1	[-]
Posts: 6253 Apr 29 08 12:37 PM Reply Quote More My Recent Posts	Just tell her no. She cannot use E&M codes because a Ph.D. is not qualified to TREAT medical problems, only mental health problems. E&M codes contain a medical decision making component. There are a very few exceptions, for instance, the workers comp system in California allows a PhD to use E&M codes. She cannot get around the mental health limitations by trying to access the medical benefits. It is just not going to work. Sharon
TWNGRLS	RE: Coding	#2	[-]
Posts: 16 Apr 30 08 6:33 AM Reply Quote More My Recent Posts	Hi, I am not disputing what you are saying, because I am confused and that is why I came here for other opinions. However, when I read the E&M guidelines, its says under instructions for selecting level of service, that you have to recognize 6 out of 7 criteria. The first three components should be considered key components, History, Examination, medical decision making. However, it also says that an exception to the rule is in the case of visits that predominantly consist of counseling. When counseling and/or coordination of care dominates more than 50% of time (paraphrasing) then time may be considered the key or controlling factor to determine the level of care. So, that is where I am confused or unsure, if my provider fits that criteria what are the guidelines of using E&M codes. I can't find anywhere where it says that only physicians can use E&M codes. Again, I am not questioning what you are saying, I am needing some concrete (written) documentation that says that E&M codes can only be used by medical providers. Thanks again!
Doo	Re: RE: Coding	#3	[-]
Posts: 6253 Apr 30 08 7:51 AM Reply Quote More My Recent Posts	It's not about choosing the level of care, it's that she cannot do the medical decision making for PHYSICAL issues. She wants you to use a physical diagnosis (which she is not qualified to give) to back up medical decision making (which she is not qualified to do) for a PHYSICAL problem. I don't have my book in front of me, but somewhere in the front it says to use the MOST specific code available. The psych codes are THE most specific codes available for the services she is providing. Her next question is likely to be, "then why is counseling in the E&M codes if I cannot use it?" and the answer is, because sometimes primary care doctors spend more time in a session doing counseling than doing anything else. It is not often, but it does happen. Primary care doctors, for most insurances, cannot bill the psych codes because they are not psych specialists (most insurances will only pay psych codes to a psych specialist). The last time I asked the American Medical Association about using an E&M code vs a psych code for something for a psychiatrist (an MD), they told me the bottom line is ALWAYS to choose the most specific code, and for any mental health professional, probably more than 95% of the time that will be a psych code. I don't know what state you are in, but I'm sure you could also ask the ethics committee of your state psychological association, or the ethics committee of the American Psychological Association. If it makes any difference, I've had this same discussion with members of a regional association's ethics committee, who came to me for advice. Sharon
Doo	Re: RE: Coding	#4	[-]
Posts: 6253 Apr 30 08 7:55 AM Reply Quote More My Recent Posts	By the way, I'm confused on why she thinks she can use a medical diagnosis when she is not qualified to make that diagnosis. Mental health providers diagnose what they are treating, or what exists that they can diagnose. She can see a patient has a broken leg, but she can't use that as a primary diagnosis to justify therapy. It is frustrating when a doctor says, "someone told me I could do XXXXXXXXXXX" and then you have to try to find something in writing saying they cannot do XXXXXXXXXX. It is much easier if that elusive "someone" provides evidence that you CAN do it (which almost never exists). Sharon
TWNGRLS	RE: Coding	#5	[-]
Posts: 16 Apr 30 08 8:19 AM Reply Quote More My Recent Posts	Hi again, I think that I was being a bit confusing when I said about the medical diagnosis being primary. I don't mean that she will use the medical diagnosis, I meant that she sees a lot of patients in which different types of cancer is their primary diagnosis. Their primary doc or oncologist sent them here for coping techniques and couseling about their diagnosis (which my provider specializes in). She also meets with family members of the patient. It often happens that they have no other symptoms or mental health issues other than coping with their cancer. I think that her thought was that she could bill E&M because she is seeing them in relationship to their cancer, not for things like depression or suicidality. She told me that her previous billing person billed this way in the past and that she wanted me to check into this further. I talked to her today and told her I was doing research on the idea and I am concerned that her previous biller (many years ago) was billing incorrectly and it could have been deemed fradulent. Of course, at that point she said that the insurance companies paid it and never questioned it and I should check into that. Therefore, I opened up a whole new can of worms for myself! I am continuing to check with all my resources and really appreciate your thoughts on things. I am glad I have this resource to use for things like this because there are not a lot of billers/coders in mental health and most providers use billing services who don't want to give out any information and don't like to network. Thanks again. Tammy
Doo	Re: RE: Coding	#6	[-]
Posts: 6253 Apr 30 08 11:14 AM Reply Quote More My Recent Posts	So she is seeing them for adjustment issues. That's typical. But them having cancer really has nothing to do with what she is billing. Here is the mental health billing guide put out by my Medicare carrier. If you look at the bottom of page 12 and the top of page 13, it will tell you that Medicare does not pay psychologists (designated by the initials "CP" for clinical psychologist) for codes that include an E&M component. I keep coming back (in my mind) to the fact that it is outside her scope of practice, and she is trying to use a less specific code merely to increase her reimbursement. That just flies in the face of what we ALL know about medical coding and billing. I did try to bill one of the after-hours add-on codes to my local Big Blue, and they denied it as "invalid for provider type". They don't have physical medicine codes attached to PhD fee schedules. Sharon
Doo		#7	[-]
Posts: 6253 Jun 13 12 2:55 PM Reply Quote More My Recent Posts	I was pointed back to this topic, although it is 4 years old. There now exists behavioral health CPT codes, for patients who are being seen primarily due to a physical problem, whose behavior because of that physical problem is causing them difficulties, and who don't have a mental health diagnosis. An example would be a child with diabetes who physically struggles with his parents over his injections and keeps sneaking candy. His behavior is making his physical problem worse. Here is an article about the codes (96150 thru 96155) and how to use them: http://www.carepaths.com/...th-a-physical-diagnosis/ Sharon Moderator Nothing I say shall be construed as legal advice; always check with your own financial or legal advisors for your specific situation.

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