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  1. J

    Wiki MPFS Proc Stat "R"

    CPT 90846 has been assigned an "R" on the MPFS meaning restricted coverage/special coverage instructions apply. Does this mean that the MAC will request the notes before paying? I found one LCD on this code, but other than some documentation guidelines, is there anything else that one would need...
  2. J

    Wiki CPT 90846 "R" Proc Stat on MPFS

    CPT 90846 has been assigned an "R" on the MPFS meaning restricted coverage/special coverage instructions apply. Does this mean that the MAC will request the notes before paying? Is it a potential audit trigger? Has anyone had any experience getting paid with this code? Thanks.
  3. J

    Wiki psychotherapy time support

    Some payers require a psychotherapy counseling session start/stop time. Has anyone been through an external CMS audit where a session start/stop time was requested to support a documented total time?
  4. J

    Wiki Psychotherapy start/stop time

    I am working through an audit issue with a company that is governed by three different MACs. Each LCD indicates that "time" not "start/stop" time is required for psychotherapy sessions. I have pointed out that each LCD references the HIPAA law which indicates that counseling session start/stop...
  5. J

    Wiki ROS under 2023 E/M guidelines

    I totally get the new E/M guidelines; I have to use them every day. Thank you for the reply... It prompted my thinking...I guess my question goes more to whether the documentation without any ROS is adequate to communicate appropriate clinical care. It seems to be within the realm of a peer...
  6. J

    Wiki ROS under 2023 E/M guidelines

    I am encountering physician E/M notes without any ROS being documented. Even though the 2023 E/M guidelines now state a "medically appropriate history and/or examination" is required, does this mean that a physician who is billing outpatient can just skip this? I believe that the taking of a...
  7. J

    Wiki Billing for time

    Is there a binding or persuasive standard that indicates E/M CPT codes can only be selected based on total time if the note was completed on the DOS service? I have Clinicians billing for total time, but their notes are being completed/signed 2 days later. From what I can find, this is OK as...
    • JRae5M
    • Thread
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    • Forum: E/M
  8. J

    Wiki E/M Billing - time

    I have been seeing more notes where Clinicians are choosing E/M levels based on time, but the note has an electronic signature for 2 days or so after the DOS. This makes me nervous that an outside auditor would question the time vs work on the DOS. Is there an official guideline that I could...
  9. J

    Wiki Psychotherapy codes question

    This code does require that the Clinician indicate the therapeutic intervention utilized (i.e., CBT, solution-focused therapy, etc.). One must consider the scope of state license as well as clinical practice/education. CPT indicates that this code can be billed by physician or other qualified...
  10. J

    Wiki Interactive Complexity and Prolonged Services

    When performed with psychotherapy, the Interactive Complexity component (90785) relates only to the increased work intensity of the psychotherapy service, and does not change the time for the psychotherapy service. Per WPS, documentation needs to support the medical necessity for the extended...
  11. J

    Wiki billing dementia as primary

    As of this month, we are experiencing a denial when billing dementia as the primary reason for the visit. This is for CPT 90791 and CPT 90792. Up until now, we have billed with the underlying condition first-listed followed by the dementia code. We are now being told that this is not acceptable...
  12. J

    Wiki 96136/96137 confusion

    When services are spread over multiple visits, all codes are billed together on the last DOS when all work is complete. https://www.apaservices.org/practice/reimbursement/health-codes/testing-code-faq.pdf
  13. J

    Wiki Skilled nursing facilities

    Nursing Facility CPT codes CPT 99308 and CPT 99309 are different levels of Subsequent Nursing Facility care listed under the E/M section. These are separate billing codes and cannot be combined as they have different levels of key components, times and patient presentations.
  14. J

    Wiki Vascular dementia coding order

    The 2019 ICD-10-CM Expert lists a "Code first" rule for vascular dementia: "Code first the underlying physiological condition or sequelae of the cerebrovascular disease." Based on this, the Provider has submitted the following: (I10) Essential (primary) hypertension (F01.50) Vascular dementia...
  15. J

    Wiki E/M Code with 90833

    Documenting Psychotherapy Time When billing time-based codes the CPT time rule applies: EXACT times must be documented in the medical record. Start/stop time is best documentation. Below is a useful tool for psychotherapy documentation. www.cgsmedicare.com/pdf/psychotherapy_checklist.pdf
  16. J

    Wiki Suicidal Ideation

    It always helps to have support from the documentation. If the clinician has stated that there is active SI with a viable plan, then this would be considered something that could produce imminent death w/o clinician intervention. The clinician's management option would point you to the severity...
  17. J

    Wiki ? Exam elements

    Any number of + or - descriptors within the "Speech" bullet is an indication of assessment of "Speech" as part of the Psychiatric Exam.
  18. J

    Wiki Anxiety attack

    There are several ICD-10-CM codes that you can look at: F41.0 Panic disorder [episodic paroxysmal anxiety] without agoraphobia- applicable to panic attack, panic state F41.1 Generalized anxiety disorder-applicable to anxiety reaction, anxiety state Most likely, you will need to query...
  19. J

    Wiki changing level of E/M

    I do internal auditing of E/M levels. I was initially asked to do this in order to educate the provider on how to improve documentation in order to better support the billed level of service in the future. The company is now asking me, pre-billing, to place an addendum on the provider's note...
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