Being a patient's attending M.D. (Internist), I frequently see people who don't have the cash or coverage to see a $300.00/hr. psychiatrist, especially when they receive 10min for discussion of their issues of face-to-face service only to essentially get their prescriptions. Psychiatry policy frequently runs "no monthly follow-up, no more prescriptiosn. When they rather see me and I used an ICD-9 dx such as depression, bipolar disorder in remission; schizophrenia with recurrent psychotic features, adjustment disorders, panic issues with agorophobia, etc. etc., I usually spend approximately 30-45 min with them, which may back-up my patient schedule. I heard that if the ICD-9 code, is listed that Medicare and other payers will down-code a 99215, 99215 plus 99354, 99214. Instead of being paid approx. $135.00 for a 99215, I'll receive an EOB and see I received $85.00; what's the CMMS policy of a patient's primary M.D.managing a psyche patient? If I'm going to be down-coded, why not send all insurance patients to the E.R.where the billing will be ten-fold the office allowed charge. Are modifiers involved? Haven't got a clue. Thanks, for any answers/experience.
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About this Question
- Posted by Robert Bader, M.D. 9 months ago. There are 8 posts. The latest reply is from Robert Bader, M.D..
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I also observed the following:-
Payment for office visits with a mental health diagnosis code has traditionally been discounted by Medicare for primary care. Many managed care plans do not pay family physicians for the provision of psychiatric care, even though family physicians are frequently in the position to diagnose and provide the care.
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Give me some time to find out ways to solve this problem -
If I use a psychiatric diagnosis such as Major Depressive Disorder, single episode, moderate (296.22) and after your research, Sanjit, will be paid on a "discounted" basis, and spend at least 70 min. with patient, I deserve the use a 99215 plus 99354 as per criteria. My concern is being a target in Medicare or another payer's cross-hairs ("red flagged")when my professional experience and services can stop a patient from repeatedly going to the E.R., especially common with anxiety/panic disorders. MDM requiring use of atypical anti-psychotics, ADM, mood-stabilizers, antianxietylitics, etc., is no kid's play, whether you're primary care of a psychiatrist. I would additional feel sad and upset if a new office policy dictated that all MEDI-MEDI patient call-ins be directed to hospital E.R.'s. Thanks. I'll wait for your response. Robert F. Bader, M.D.
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I am sure, you will understand that whatever I expressed in last post is my observation over few years, but not guidelines. I share the same views what you think. In fact, Coding 99215 and 99354 is more logical than coding 99214 in place of 99215, as per coding guidelines in such scenario.
The only alternative to such problem, is to try with Letter of Appeals with proof of documentation to support the E/M level. -
thanks for the response Sanjit. Back to the first quesion...does Medicare pay a lesser amount for an e/m code attached to a psychiatric dx? That's my overarching concern. Dr. Bader.
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I had witnessed both discounted payment or denials with pshychiatric Dx. As per my observations this is a trend, but not a guideline.
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Denial experts try hard to get the expected reimbursements for this. -
I will come up with some specific info and analytical explanation asap.
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Thank you as always Sanjit...Dr. Bader. It's a serious time issue with patients taking 45-60 minutes with histories of depression, panic disorder, schizophrenia, bipolar, separation, divorce, becoming opioid or alcohol dependent and they refuse to see a psychiatrist and feel their Church isn't able to deal with the "heavy angry thoughts." As per several studies within the past five years, PCPs tend to have better out-comes than psychiatrists in the psychopharmacolic treatment of non-violent psychiatric patients. Might the CCI or LCD regulations might have a more statuary answer to why PCPs meeting E/M guidelines and documentation aren't seen as equal or more valuable than the "specialist"?
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