E/M vs Add-on Codes for Psychotherapy
What are Add-on Codes?
An add-on code is a code that can only be used in conjunction with another, primary code and is indicated by the plus symbol (+) in the CPT manual. The add-on code concept was developed to eliminate the redundancy of work that occurs when you provide two services on the same day (i.e., reviewing a patient’s medical record, greeting the patient). The psychotherapy add-on code you select indicates the approximate length of the psychotherapy. Let’s understand the difference between E/M codes and Add-on codes for psychotherapy.
In the new Psychiatry codes there are three different types of add-on codes:
- Timed add-on codes to be used to indicate psychotherapy when it is done with medical evaluation and management
- A code to be used when psychotherapy is done that involves interactive complexity
- A code to be used with the new crisis therapy code every 30 minutes beyond the first hour. On the claim form, the add-on code is listed as a second code
What are E/M codes?
The E/M codes are generic in the sense that they can be used by all physicians to describe general medical services. The evaluation and management (E/M) codes are found in the first section of the AMA CPT manual. The first two digits of this code set are 99. Code selection is based on whether the patient is new or established, the setting (outpatient, inpatient, nursing facility, etc.), and on the complexity of the service provided, which is based on the nature of the presenting problem. There are specific documentation requirements when using these codes.
E/M vs Add-on Codes
If you are doing psychotherapy in conjunction with an E/M service, you must choose the E/M code on the basis of the work performed, not on the basis of time spent providing counseling and coordination of care. The time listed for the psychotherapy add-on code accounts only for the time spent providing psychotherapy. Any time spent providing E/M services should not be included in the psychotherapy add-on time.
You can code and document for whatever level of E/M is warranted by the patient’s presenting problem that day and select the add-on psychotherapy code based on the length of time of the psychotherapy provided. Since the current psychotherapy codes are not for a range of time, as the old ones, but for a specific time, the CPT “time rule” applies. If the time is more than half the time of the code (i.e., for 90832 this would be 16 minutes) then that code can be used. For up to 37 minutes you would use the 30-minute code; for 38 to 52 minutes, you would use the 45-minute code, 90834; and for 53 minutes and beyond, you would use 90837, the 60-minute code.
Correctly Using E/M and Add-on Codes
In some cases, you can bill both – if you provide a medical service (the E/M) and the psychotherapy. If you are a physician billing the E/M (psychologists do not bill E/M) and performing psychotherapy, you must determine the E/M level based on the levels of history, examination, and medical decision-making. For documentation, use one section of the note for the E/M – and label it E/M – and use the other section for a therapy note.
Simply talking about medications is not enough to justify billing an E/M. Likewise, psychiatrists can’t just document the time spent counseling – they have to document something about what went into the session. He has told his clients to document one section of the note for the E/M – and label it as such – or to have two notes, an E/M note and a psychotherapy note.
Although E/M codes – the ones used by physicians for “office visits” – can be billed by time if more than half of the session time is spent on counseling, the E/M time cannot be used for psychotherapy. This is complicated, and even top coders aren’t sure why CPT made the changes.
Since many mental health professionals don’t do their own coding but send it out to consultants, it’s important to be very clear, in the documentation. It’s also important to be clear because someday, your notes are going to be audited – by Medicare, or by a commercial payer – and if the documentation doesn’t support what you billed, you will have to give back the money.
For accurate Psychotherapy medical billing, knowing your CPT codes is the most important thing. E2E Medical Billing Services is known for its accurate Psychotherapy billing and coding. To know more about our medical billing and coding services call us at 888-552-1290 or write to us at [email protected]