Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.

Tuesday, February 26, 2013


There seems to be a frenzy of questions about CPT coding floating around cyberspace.

One issue that's been popping up is the split in billing. Some people are doing it, with a rough guideline of 60% CPT, and 40% E/M. Others are not. Some claims have already been rejected because of the absence of split billing.

There are all kinds of questions about what constitutes a 99212, or a 99215, arguments that confuse the value of our work with the question of which is the appropriate E/M code.

People, they're not related.  The E/M code is what you do to satisfy some sub-regulation of a regulation. The value of our work is infinitely more important, and correspondingly less understandable to anyone whose job it is to reimburse the work.

If you're still confused, read my E/M posts more carefully, because I couldn't possibly be anything but crystal clear in my exposition.

But enough about me. What do you think of my template?

Actually, it's not my template-it was developed by a colleague of mine, with some input and graphic design updating from yours truly. Also, you haven't seen it yet, so why am I asking?

First a disclaimer. Since the template was devised last December, I have made a lot of my own changes to this template, as has my colleague. I'll get to the ideas behind the changes, but I wanted to present it in an early version, so people can use and modify it as they see fit.

Another disclaimer: This template has not been endorsed by any agency involved in CPT and E/M coding, official or otherwise. It is not a guarantee of reimbursement. And I am not responsible for the fact that it may not be the right way to code. So you can't blame me, or my colleague, if you use it and something goes wrong.

I just find it convenient for my needs. And I'm presenting it with my colleague's permission. So here it is:

These are some of the changes I've made and why:

1. I've added a section entitled Plan/Discussed with Patient. I did this because otherwise, if I look back at the note a year after it was written, I won't be able to figure out what I did, or what my reasoning was.

2. I left the ROS section blank, to be filled in, because as it stands, it only deals with one organ system, and there are often others that need to be commented on.

3. I deleted the "severity" blurb under HPI, because severity is only 1 of the elements of history. I replaced it with: 

Location Quality Severity Duration Timing Context Modifying Factors Assoc. Signs/Sx

to remind myself of other HPI elements.

4. I removed anything that was there to remind me of what I need to satisfy that component of the note, e.g. "Problem Focused 99212".  I felt that should be in my head, not the note.

5. The template was originally designed to fit on one page, which my colleague prints out. I fill it out electronically, so I expanded it to two pages.

4. I added some additional elements to the CC and Psychotherapy sections. My colleague has since added others.

Bottom line: This is a work in progress, and it's helpful in some ways, and a royal pain in others.  You can use it, or elements of it, if you find it helpful. Please use appropriate attribution.