Wiki Please help is my mental practice over charging me?

Create Wiki
C

Celticmussin84

New
Messages
3
Location
covington, KY
Best answers
0
I'm a hospital coder mainly in cancer care and when I checked my bill statement I noticed I was charged for this year and last charges of 90833T for one visit and another visit 90837T with 90833T.
Also for one they charge a 99214 with a 90833T and 908337T?
I am an established patient and both these visits where for quick 15 mins visit to see how I am doing on my medication, is this right?
In new 2025 CPT book the code 90833T has a red circle for it being a new code, so how can they use this code in 2024? Am I missing something please help? Its an almost $300 bill even after insurance.
 
Last edited:
If you provider is only doing medication management, they should be billing E&M codes 99211-99215 since you are an established patient, and the level would be based either on MDM or total time spent on the patient on the day of the encounter. They should only be billing 90833 if they did psychotherapy in addition to the medication management and for 90833 the minimum time is 16 minutes up to 30 minutes because 90833 is an add-on code.

For 90837 not an add-on code, it is a stand-alone psychotherapy visit with a minimum time of 53 minutes of time spent on psychotherapy techniques.

As for the 90833 being listed in the 2025 CPT book with red circle indicating 90833 is a new code, there may be a misprint with the CPT book because 90833 was established effective 01/01/2013 and last revised 01/01/2017.
 
The code that is most appropriate depends on whether your provider is an MD or APP, or a therapist. But maybe you should call and ask them to explain the charges, as it's impossible for any of us to comment without seeing documentation (and please don't share it). Also, check to see if the insurance processed the claim correctly. Is your provider in-network? Were your visits pre-authorized? Many factors could come into play here.
 
My psychiatrist bills and E&M with the 90833 code because 90833 is an E&M add on code. When billing for a psychotherapy session alongside an E/M service, you would report the E/M code and then add on the 90833 code to capture the psychotherapy component. There are two sets of psychotherapy codes. One set is the set of codes to report psychotherapy only. (90832, 90834, 90837) While these are most frequently reported by social workers, psychologists and therapists, they can be reported by psychiatrists, psychiatric NPs and PAs if medication management is not performed at the same visit. The second set of individual psychotherapy codes set are add-on codes, +90833, +90836, +90838, which are added on to an E/M service, when both medication management and psychotherapy are performed on the same calendar date.
 
dvarn567 said:
My psychiatrist bills and E&M with the 90833 code because 90833 is an E&M add on code. When billing for a psychotherapy session alongside an E/M service, you would report the E/M code and then add on the 90833 code to capture the psychotherapy component. There are two sets of psychotherapy codes. One set is the set of codes to report psychotherapy only. (90832, 90834, 90837) While these are most frequently reported by social workers, psychologists and therapists, they can be reported by psychiatrists, psychiatric NPs and PAs if medication management is not performed at the same visit. The second set of individual psychotherapy codes set are add-on codes, +90833, +90836, +90838, which are added on to an E/M service, when both medication management and psychotherapy are performed on the same calendar date.
Click to expand...
That makes sense when both services are done. What I am having trouble with is that these visits are for drug medication management only. They only list 15 minutes at most and its her just asking how I am doing and I say good and I don't have any questions when she ask. So how can she charge 99214 with 90833 when no therapy session was done and there was no new dx added or prescription change? Thank you everyone for your help with this issue, I really appreciate any help. It is just just not adding up for me that a 15 minute visit when no new dx, or prescriptions changes or therapy performed can produce a bill of $280 after insurance was charged.
 
You must log in or register to reply here.
Top