CMS: Lot of errors billing psychotherapy services when E/M visit is involved

October 15th, 2014 - Scott Kraft
Categories:   Billing   Coding   Evaluation & Management (E/M)  
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The Comprehensive Error Rate Testing (CERT) program Medicare uses to assess the accuracy of provider billing has uncovered a big source for mistakes – documentation problems when a patient is receiving psychotherapy services on the same date as an E/M encounter, according to CMS.

There are really two takeaways coders and billers need to have to get these services billed correctly on a consistent basis. A big part of it will also involve proper physician documentation.

First, there are two different sets of psychotherapy codes, one set that are add-on codes for E/M services and one that are not. When an E/M service is not billed on the same day of service, you bill these codes:
  • 90832, psychotherapy, 30 minutes with patient and/or family member;
  • 90834, psychotherapy, 45 minutes with patient and/or family member;
  • 90837, psychotherapy, 60 minutes with patient and/or family member.

When an E/M service is being billed on the same date of service, you bill these codes:
  • 90833, psychotherapy, 30 minutes with patient and/or family member when performed with an E/M service;
  • 90836, psychotherapy, 45 minutes with patient and/or family member when performed with an E/M service;
  • 90838, psychotherapy, 60 minutes with patient and/or family member when performed with an E/M service.

A psychotherapy service that is less than 16 minutes long should not be billed.

The second element to the confusion is that issue of the length of the service. When you are billing the psychotherapy service alone, then the time should be documented for purposes of justifying the code chosen.

When you bill both services, the time spent on the psychotherapy service must be documented separately from the time spent on the E/M service. None of the E/M time can be counted toward the psychotherapy service and both services must be medically necessary.

Unlike in past years, the psychotherapy codes are no longer dependent on the place of service.

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