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Psychiatry Coding & Reimbursement Alert

You Be the Coder:

Choosing E/M Code on Basis of Time? Not so Fast

Question: I am new to psychiatry coding. I know that psychiatrists are allowed to report E/M codes. Can the selection of the level of the E/M code be based on time on the basis of counseling and coordination of care? I was looking to do this but one of my colleagues said that this cannot be done when our psychiatrists perform an E/M service.

Michigan Subscriber

Answer: You have not mentioned if your psychiatrist performed an E/M service and a psychotherapy service on the same calendar date or if he performed the E/M as a standalone service.

If your clinician performed the E/M service as a standalone service (not in conjunction with same day psychotherapy), then you choose the level of the E/M code based on either the key components (i.e., history, examination, medical decision making) or on the basis of time. You use time as the basis for selection of the level of the E/M code when more than 50% the time is spent on counseling and coordination of care.

On the other hand, if your clinician is performing the E/M service along with same day psychotherapy, you cannot use time as a basis for selecting the level of the E/M code. You should select the appropriate level of E/M code (such as 99213, Office or other outpatient visit for the evaluation and management of an established patient…) based on the work (i.e., key components) involved in the service and not on the basis of time.