I work at a Behavioral Health office in North Carolina. We have all types of providers from a MD-to a LPC. I have a question and I am hoping someone can help me with this:
A new patient comes in and sees a LCSW for counseling. The LCSW refers the patient to see an MD to see if medications would be appropriate to treat this patient in addition to counseling. The LCSW charged a 90791 on the first visit. The MD sees the patient a few days later but can only charge a 99205. I know the MD could charge a 90792 but we are billing a MCO which dictates a higher level of documentation referred to as a CCA (The MCO essentially have a different set of rules for the 90792 then the AMA) and currently our EMR is not set up to do this so we have told our MD?s, PA?s and NP?s they cannot use 90792 and must use the 99201-99205 codes until we can get our system updated. I have told them because of the 3 year rule (requirements for a new patient 99201-99205 and we bill as a group they cannot. My understanding is because we bill as a group the patient would be considered established because they have been seen by a provider within the group regardless of the type of provider and if we billed as individuals they could do that but we don?t. What is your opinion on this?
My management is having a hard time getting the providers to understand this. They think because it is a different type of provider (therapist vs. prescriber) they should be able to get paid for a new pt.
A new patient comes in and sees a LCSW for counseling. The LCSW refers the patient to see an MD to see if medications would be appropriate to treat this patient in addition to counseling. The LCSW charged a 90791 on the first visit. The MD sees the patient a few days later but can only charge a 99205. I know the MD could charge a 90792 but we are billing a MCO which dictates a higher level of documentation referred to as a CCA (The MCO essentially have a different set of rules for the 90792 then the AMA) and currently our EMR is not set up to do this so we have told our MD?s, PA?s and NP?s they cannot use 90792 and must use the 99201-99205 codes until we can get our system updated. I have told them because of the 3 year rule (requirements for a new patient 99201-99205 and we bill as a group they cannot. My understanding is because we bill as a group the patient would be considered established because they have been seen by a provider within the group regardless of the type of provider and if we billed as individuals they could do that but we don?t. What is your opinion on this?
My management is having a hard time getting the providers to understand this. They think because it is a different type of provider (therapist vs. prescriber) they should be able to get paid for a new pt.
90792 vs. 99201-99205
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