Are You Making this Common Billing Mistake?

How to accurately bill medical and psychotherapy services on the same day, for the same patient.

More and more opportunities arise for qualified healthcare professionals to provide medical and psychotherapy services to the same patient on the same day. CMS indicates through MLN Matters article SE1407 that these services are payable if they are significant, separately identifiable, and billed appropriately.

The most common error that occurs when billing out this particular situation is the unclear documentation regarding the amount of time spent on the psychotherapy services. The psychotherapy code is chosen based on the time spent providing psychotherapy, versus the E&M code, which is chosen based on the elements of the history, physical exam and medical decision making.

These psychotherapy codes (for services provided in addition to an E&M service) are considered “add-on” codes and need to be reported with the appropriate primary service on the same date of service. The time used for the E&M code is not included in the time involved with the psychotherapy service. These services need to be distinct and separately identifiable. The level of the E&M service is determined first then the appropriate psychotherapy code is reported.

Here are a few examples to help illustrate the point:

Reporting Psychotherapy services provided in ad
dition to an E&M service:

E&M Code + 90833: Psychotherapy, 30 minutes with patient and/or family member when performed with an E&M service
E&M Code + 90836: Psychotherapy, 45 minutes with patient and/or family member when performed with an E&M service
E&M Code + 90838: Psychotherapy, 60 minutes with patient and/or family member when performed with an E&M service

Reporting Psychotherapy services without an E&M service:

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

Again, the most common mistake in this situation is unclear documentation regarding time spent on psychotherapy services. Remember, these services need to be distinct and separately identifiable. Document the valuable time spent with patients!

Your questions and feedback are very important to us. Please contact us with any ideas or questions you would like to see in the SCHA-MI Billing Corner. We are here to help!

Your SCHA-MI Billing Team,

Kris Knitter
Lisa Champion-Julian
Sherry Bowen
Cathy Everling