Novitas Solutions, Inc. in collaboration with CMS (Centers for Medicare & Medicaid Services) continues to focus on lowering CERT (Comprehensive Error Rate Testing) claims paid error rate. Currently, one area of concern identified in the CERT data is lack of documentation of face-to-face time to support the code billed.
Psychotherapy service codes include therapeutic maneuvers, such as behavior modification and supportive or interpretive interactions applied to produce a therapeutic change, along with ongoing assessments and adjustment of psychotherapeutic interventions. The medical record must indicate length of time spent in the psychotherapy encounter.
When billing psychotherapy with an E/M, the documentation must support that the E/M service meets the history, exam and medical decision-making requirements.
Documentation requirements and detailed guidance are found in our LCD (Local Coverage Determination), L35101 - Psychiatric Codes.
The following timed psychotherapy codes apply in all settings (e.g. office, outpatient, inpatient, etc.). Select the code that most closely matches the actual time spent.
Note: Do not report psychotherapy codes for any session lasting less than 16 minutes.
E/M (Evaluation and Management) services performed on the same day as a psychotherapy service (same physician or other health care professional) must be significant and separately identifiable in order to bill both psychotherapy and E/M.
The following time based psychotherapy codes are "add-on" codes to E/M services (99201 - 99255, 99304 - 99337, or 99341 - 99350). Select the psychotherapy code that most closely matches the actual time spent.
Select the E/M service based on the key components of history, examination and medical decision-making. You may not use time to select the E/M service.