30 min required for add on therapy with E/M?

[finalpsychyear]

Please can someone clarify or point to some resources. I am getting conflicting info. I was under the impression you could technically have a 20-25 min total visit time for a 99213/99214 plus add on code provided there was at least 16 min therapy. I am not saying that it is not ideal to have a 30 min block for a EM and add on but if your seeing a patient more often where your tapering or making mild changes you may need only a few min of the EM.

Is technically having a 20-25 min visit with 16 min add on allowed or does the entire time have to be a 30 minute block?

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[TexasPhysician]

Does not need to be 30 min

 

[forchinet121]

Please can someone clarify or point to some resources. I am getting conflicting info. I was under the impression you could technically have a 20-25 min total visit time for a 99213/99214 plus add on code provided there was at least 16 min therapy. I am not saying that it is not ideal to have a 30 min block for a EM and add on but if your seeing a patient more often where your tapering or making mild changes you may need only a few min of the EM.

Is technically having a 20-25 min visit with 16 min add on allowed or does the entire time have to be a 30 minute block?

Are you in private practice or employed? If you’re employed with a fixed income not dependent on production I definitely wouldn’t be billing add on therapy for a visit under 30 minutes since if you do it a lot it could be considered shady but technically you could if in private practice

 

[surfguy84]

If someone is stable on meds, illnesses in remission, nothin new medially, how long are people really needing to spend on E/M? 2-4 minutes? I could easily see an appt w therapy lasting 20 minutes. Certainly this isn't true for every patient.

 

[finalpsychyear]

Are you in private practice or employed? If you’re employed with a fixed income not dependent on production I definitely wouldn’t be billing add on therapy for a visit under 30 minutes since if you do it a lot it could be considered shady but technically you could if in private practice

Both. But at the employed/contract place I was told you are not able to bill add ons for 20 min appts slots only for 30 min slots. This seemed incorrect to me. 90% of my patients there for the first 20 min usually go on and about their life stressors while I give empathic responses and give some validation so mostly supportive therapy. Then the last 5 min are usually meds related so in reality a 20 min slot is always 25 min. The clinic has a shortage of counselors and even then its usually q monthly for those that have one due to demand.

 

[allantois]

I mean if you are booked 3 patients an hour and you will be billing psychotherapy add ons on all of them, this sounds like a sure way to invite an audit

 

[TexasPhysician]

I mean if you are booked 3 patients an hour and you will be billing psychotherapy add ons on all of them, this sounds like a sure way to invite an audit

Yeah it would be fishy to do all patients E&M in 4 min.

Real world could be a simple ADHD 99213 in 3 minutes and 2 99214 + 90833 in 57 minutes. Or something similar.

With telepsych, it isn’t unusual for me to get on with someone stable at their work with 2 problems. This is most common with people that want to be scheduled around lunch. They just want refills and to enjoy their lunch. That 99214 could be under 2 minutes.

The trick is appropriately scheduling a mix that want therapy with those that want quick interactions. I’m not going to force someone to spend 25 minutes with me, but with insurance, it is poor business to only schedule 2 patients per hour that end up being just 99214’s.

 

[surfguy84]

Yeah it would be fishy to do all patients E&M in 4 min.

Real world could be a simple ADHD 99213 in 3 minutes and 2 99214 + 90833 in 57 minutes. Or something similar.

With telepsych, it isn’t unusual for me to get on with someone stable at their work with 2 problems. This is most common with people that want to be scheduled around lunch. They just want refills and to enjoy their lunch. That 99214 could be under 2 minutes.

The trick is appropriately scheduling a mix that want therapy with those that want quick interactions. I’m not going to force someone to spend 25 minutes with me, but with insurance, it is poor business to only schedule 2 patients per hour that end up being just 99214’s.

This is what I'm trying to figure out. Do you schedule three per hour and just hope one is quick?

 

[TexasPhysician]

This is what I'm trying to figure out. Do you schedule three per hour and just hope one is quick?

In my insurance practice, I schedule 3-4/hr. I expect some no-shows and some easy patients.

 

[annoyedpsychiatrist]

I probably bill 75% of my patients with psychotherapy add on code but if patients are stable and not that complex then i dont think its unreasonable to spend a few mins discussing meds and the rest towards adjunctive therapy. But i actually do CBT interventions and other things when I bill it. Some people only require a few minutes discussing medicaitons. Some require a lot more. Very patient dependent. Probably more fishy if you bill 100% of your patients for therapy add on code as some dont really require anything besides a very simple med check.