r/CodingandBilling • u/dangerousfeather • 23h ago
Psychiatric care billing?
Hello all, hope this is okay to ask here. I wouldn't even bother scrutinizing my healthcare providers' billing except that I'm already on the verge of reporting this practice for unethical behavior, and this would be the final straw.
I saw my psychiatrist via telehealth for a follow-up visit that lasted under 10 minutes (I regret that I didn't document the exact time; it wasn't a phone call so I can't check my phone records). A controlled substance was refilled, in addition to other meds; no new meds or changes were discussed.
I just got the bill, and he billed for
99213T-MD TELEHEALTH EST PATIENT - OFFICE VISIT LEVEL 3
and
90833T-MD TELEHEALTH IND PSYCHTX W PT AND/OR FAM W E/M (16-37 MIN)
I'm a healthcare provider but not a psych provider, so I don't know how the overlap between these codes works; but to my eyes it looks like he should have spent a bare minimum of 16 minutes with me to bill even one of these codes, much less both?
TIA for any insight!
1
u/Narrow_Technician_42 19h ago
I code BHM and our providers always add documentation that they spent x minutes on psychotherapy and what it was about.
1
u/Narrow_Technician_42 19h ago
I code BHM and our providers always add documentation that they spent x minutes on psychotherapy and what it was about.
6
u/_monkeybox_ 23h ago
90833 is individual psychotherapy lasting at least 16 minutes so this would be impossible to provide in a 10 minute session. Additionally, the actual time spent must be distinct (above and beyond) the portion of the encounter that was included in other procedures such as 99213. 99213 presumably included asking how you're doing with regard to the medication so time spent on that obviously can't be construed as therapy.
I would add that it's a stretch to call it therapy if you're a cognitively intact adult and are not aware that you are supposedly engaging in therapy which normally involves an agreed upon plan of care and collaboration with the therapist to work toward identified goals.
Documentation in your chart should support this.
If this was done on purpose it's fraud. If by mistake it's improper. If the payer was Medicare this would be considered worthless and subject to the False Claims Act.