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Mental Health Visit w/E&M and then return visit same day
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10/13/2020 @ 4:11:00 PM
Post 1 of 2

Contributor: Leann Woodman,

I am wondering how the billing would work for a patient that was seen for a mental health visit w/E&M on Zoom, so 90833 and 99212 and then later the same day the patient comes back to see a different provider for an ER follow up and that provider bills an E&M 99213.  Would we be able to get 3 separate AIR payments for this?

10/14/2020 @ 3:14:00 PM
Post 2 of 2

Contributor: Charles James, North American Healthcare Management Services

Rev Code 0900 should be billed with G2025 for Mental Health visits conducted via telehealth. I confirmed this with Novitas. In theory, the same rules that apply for multiple visits and face to face encounters should apply for G2025 telehealth visits. As a reminder: multiple visits are allowed when:

* The patient, subsequent to the first visit, suffers an illness or injury that requires additional diagnosis or treatment on the same day (2 visits), or
* The patient has a medical visit and a Behavioral health visit on the same day (2 visits), or
* The patient has his/her IPPE and a separate medical and/or Behavioral health visit on the same day (2 or 3 visits).

The ER Follow-Up visit should theoretically be payable at the AIR as well - assuming it is a separate diagnosis from the first medical e/m. There will only be one medical encounter if the ER follow-up and the E/M that occurred via telehealth were for the same diagnosis. If these medical visits were for separate illnesses or injuries, there would be two. This scenario raises a couple of questions: What was treated on the first E/M that occurred in conjunction with Mental Health via Telehealth? Why was the reason for the ER visit not addressed at the first E/M?

Since the first visit is telehealth, it is easy to assume you will have difficulty getting all of this paid correctly. My suggestion would be to contact your MAC - whoever is paying your RHC Medicare claims - I am guessing your MAC is Noridian. I recommend asking them if the rules for multiple visits in an RHC apply to G2025 and Telehealth. That's the best way to determine what will happen for you. Let us know how it goes!

Best Regards -
Charles James

Charles A. James, Jr.
President and CEO
888.968.0076 Office
314.560.0098 Cell


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