By: Sheila Haynes, CPC – Coding and Compliance Manager
As of January 1, 2021, codes for office/outpatient medical evaluation and management (E/M) care can be selected on the basis of the complexity of the medical decision making (MDM) or on the basis of the total time on the date of the encounter.
- For psychiatrists who provide E/M services along with psychotherapy, the appropriate E/M code must be determined by the level of the medical decision-making, as newly defined. Time cannot be used to determine E/M when adding on psychotherapy.
- The level of MDM should be driven by the nature of the presenting problem on the date of the encounter. Time is not a factor when code selection is done on the basis of MDM.
- Only Psychotherapy code 90833, 98036, and 90838 can be billed in conjunction with an E/M service.
- Codes 90832, 90834, and 90837 are used for encounters where only Psychotherapy services are performed. There are CCI bundling edits for these codes, that do not allow them to be billed in conjunction with E/M office visit codes. Modifiers are not allowed to override this relationship.