One of our Psychology Today readers wrote in with the following concern:
You could see if the psychiatrist will code higher and if that will make a difference. It might not. To code higher for the E/M portion, the doctor could code a 99213 which entails documenting just a little more in his notes, but perhaps if he tells you what information he needs, you could just hand him that information pre-written each week. He may not know, many psychiatrists are just coding low because they are afraid of being audited or questioned. In order to code the therapy portion of the session higher, he would need to be doing 53 minutes of psychotherapy in addition to the E/M portion. I am coding many sessions as 99213 + 60 minutes of psychotherapy (meaning over 53 minutes) and so far no insurance company has questioned it. It means I take no break between patients, and your psychiatrist may not want to do this. Some are being reimbursed much better. And Medicare rates are certainly better with the new system.
The other issue is that the psychiatrist probably bills separately for the two codes, breaking down the $450 actual charge into parts. We have no idea how to do this to allow for maximal reimbursement-- the insurance companies tell out-of-network doctors that this is proprietary information, so maybe if you call the insurance company and ask them what the allowed fee is for both codes, you could ask the doctor to break down the components so that you are reimbursed maximally. So, for example, if the doctor is billing $450 for the therapy and $0 for the 99213 portion, you would only be reimbursed for part of the allowable amount.
If this sounds ridiculous and confusing to you, please rest assured that it's no easier for the psychiatrists.