The New Psychiatrist Clockwatcher


Almost every psychotherapy patient has probably wished the psychotherapist would stop watching the clock and pay attention to them instead. The psychotherapist of course wanted to stop the session when the 50 minute hour (which became the 45 minute hour, then 25 minutes or 10 minutes) was up, to allow for writing a progress note, a trip to the toilet, and maybe a phone call, before the next session.
Since the January 1 forced adoption of E/M codes used by all other physicians your psychiatrist providing psychotherapy (sporkiatrist) may spend even more time on clockwatching. Instead of a single CPT code for your session, psychiatrists can claim multiple codes for each session, and one or more of these may include an element of time. 
Session notes could look something like this:
3:00 How are you? Fine. (Confront denial later.)
3:03 Response to increased dose of Prozac
3:08 Side effects of Prozac, including review of systems and 50% or more time spent in counseling
3:16 Check vital signs and weight
3:25 Patient angry about checking vital signs and weight during every session
3:33 Interpret transference anger as caused by mother
3:41 Explain new coding system to patient (50% or more time spent in counseling)
3:49 Stop session one minute early to allow time for calculating times for CPT coding
For a 99213 based on a total of xx minutes of E/M (50% or more time spent in counseling), and a 9xxxx based on a total of xx minutes of psychotherapy, all of which enables me to charge the patient $34.95 more than last week. 

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