So my wife has recently started visiting a psychiatrist in order to receive some evaluations and treatments, and when we received the bill, it appeared to include extra costs that we didn't expect.
Each of her follow-up visits was 30 minutes, but she was a billed using a CPT billing code for 45 minutes (CPT 90836). She questioned the psychiatrist about it, and was told that the extra 15 minutes includes time spent updating documentation and notes outside of the time for the visit. (My wife says that he was actively taking notes and updating documentation during the session, and they had to pause conversation a few times while he wrote). In addition, the billing included a code for CPT 90785, or interactive complexity. From the code documentation (http://ift.tt/2us2Y4k), the code is mostly used for describing complex interactions with children, having to deal with anxious parents, using toys to communicate with children, and/or difficult interactions due to lack of lack of language fluency, or so on. (The psychiatrist mostly specializes in child patients, but my wife is an adult and fluent in English).
My wife made an appeal with the insurance and the insurance investigated the claim, but they seemed to accept at face value the psychiatrist's explanation that the extra 15 minutes was used for documentation updates and that the interactions were complex.
My question here is, especially to people who work in medical billing: are these types of billing add-ons legitimate? Is it simply a standard billing practice, or are we being charged more than we should? Asking Reddit to get a more neutral opinion on the subject. We would like to know if we're being billed fairly. My wife is considering making a second appeal, but I would like to get Reddit's opinion on whether such an appeal is worth making. Thanks
Submitted August 10, 2017 at 01:14AM by anon_spouse http://ift.tt/2vQIA0a
