tag:blogger.com,1999:blog-26666124.post5756789871063061521..comments2024-03-18T03:28:36.581-04:00Comments on Shrink Rap: Is This It? Are We Talking Yet?Unknownnoreply@blogger.comBlogger21125tag:blogger.com,1999:blog-26666124.post-18987966148267441162008-11-24T15:20:00.000-05:002008-11-24T15:20:00.000-05:00I've had experience with billing and getting autho...I've had experience with billing and getting authorizations for med checks with psychotherapy. I agree that having a conversation about something other than the meds usually constitutes therapy (not hi, how are you doing, but actually helping the patient process feelings and stuff). After that the insurance company gets to play havoc with the billing codes -- it's like a game. There was one psychiatrist I worked with who routinely did 90807s (pediatric psychiatrist) and sometimes I had a lot of trouble getting the insurance companies to pay up. They would want me to call it a 90806 and I would have to point out that a med check was included. There were some companies that did not allow 90805s only 90862s and I never could figure out the real difference between the two. I would just ask the psychiatrist to write the note as a 90862 (their call, not mine) and make sure the correct code was on the bill. <BR/><BR/>From my own experience I think the billing codes are all just a way to make people jump through dozens of hoops and have to hire people like me to figure out ways to get the doctor paid. I really wish it could be simpler and the doctor could just do what is necessary to help the patient and then bill it as what it is.Estherhttps://www.blogger.com/profile/04892778181543416624noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-39540492902739000212008-11-23T13:09:00.000-05:002008-11-23T13:09:00.000-05:00Now that my shrink has taken a salaried position w...Now that my shrink has taken a salaried position with a treatment center, med checks have gone from 15-20 minutes down to 10 minutes, and the price has doubled. <BR/><BR/>I'm so mad, the only information he gets out of me is the basic medical stuff needed to write a prescription. Believe me, there's NO therapy going on during these med checks.<BR/><BR/>I'm thinking of switching over to the University mood disorders clinic, where you get a different resident every six months. Same level of treatment, half the travel time. >:(Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-79131077379628034092008-11-22T20:33:00.000-05:002008-11-22T20:33:00.000-05:00I do my own med checks, pour a few stiff drinks, t...I do my own med checks, pour a few stiff drinks, take the phone off the hook. Now that is therapy.Al the rest is blah blah yap yap.<BR/><BR/>My shrink is in Vegas and I haven't noticed.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-88514294197315501672008-11-22T16:42:00.000-05:002008-11-22T16:42:00.000-05:00Who says there needs to be a diagnosis or defined ...Who says there needs to be a diagnosis or defined symptoms in order for psychotherapy to be successful or helpful? Anonymous (comment 17) - I don't know why you don't consider your treatment with your psychiatrist to be psychotherapy. If you have formally (or informally) defined goals that you'd like to work towards with your psychiatrist, I would consider that to be a form of psychotherapy. <BR/><BR/>In fact, I would argue it's proactive and preventative psychotherapy - which is becoming less and less prevalent these days.Rachhttps://www.blogger.com/profile/11897760883997811787noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-70225351541405389612008-11-22T10:52:00.000-05:002008-11-22T10:52:00.000-05:00Actually, I presented to my psychiatrist with word...Actually, I presented to my psychiatrist with words nearly the same as the sarcastic quote. The work we are doing is psychotherapy. He is a psychiatrist but there is no medical tx, no dx. Any sx are seen as things to work through - find the cause rather than mask it.<BR/>My opinion is without regular time, frequency, duration, fee and so forth established and agreed upon in advance and adhered to by both the time spent may well be therapeutic but is not psychotherapy per se.<BR/><BR/>FredikaAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-11173684416616648392008-11-21T14:05:00.000-05:002008-11-21T14:05:00.000-05:00What's the CPT code for chocolate?What's the CPT code for chocolate?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-60320721207053989722008-11-21T12:38:00.000-05:002008-11-21T12:38:00.000-05:00"I'd like to enter psychotherapy so I can better u..."I'd like to enter psychotherapy so I can better understand myself, my motivations, my patterns of behavior, and resolve any unconscious conflicts that may be hampering my ability to live life fully."<BR/><BR/>My first thought when I read this was that before I knew I had MDD, these are some of the thoughts that raced through my head.<BR/><BR/>Even now in therapy addressing these is intensely important to me. I have so much anxiety and angst over "why am I here, and why am I not able to live up to my potential. How can I find and bring purpose and meaning into my life. Those thoughts really fuel my depression<BR/><BR/>...so I was sorry to hear you were being sarcastic. I thought lots of people felt the same way.<BR/>...aquaAquahttps://www.blogger.com/profile/16230285017033299419noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-59107286811754380962008-11-21T10:31:00.000-05:002008-11-21T10:31:00.000-05:00Isn't there a (messy but important) distinction be...Isn't there a (messy but important) distinction between unstructured "counseling" and structured "psychotherapy"? Isn't that what we're talking about here?<BR/><BR/>Does Counseling have a code?Neuroskeptichttps://www.blogger.com/profile/06647064768789308157noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-48464507335094494562008-11-21T10:20:00.000-05:002008-11-21T10:20:00.000-05:00The CPT coding can be really tricky.I recently rea...The CPT coding can be really tricky.<BR/>I recently read somewhere that a mom had 25 weeker, surviving triplet.<BR/>They needed to get him assessed by a psychologist for his readiness for Kindergarten.<BR/>He did have low cognitive skills but no way near mentally retarted.<BR/>He was given the wrong code of mild mental retardation and they came to know through insurance that because of that ,the bills were not being payed!<BR/>Psychologist was so sorry for the mishap and repeatedly corrected that no mental retardation was present but just thinking of trauma the mom went through till it was sorted out was just too sad!<BR/><BR/>Shrutishraddhahttps://www.blogger.com/profile/13549183128453714957noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-83477563066764637322008-11-20T23:28:00.000-05:002008-11-20T23:28:00.000-05:00""I think the bigger question to ask is, do you co...""I think the bigger question to ask is, do you consider it therapy when someone goes into therapy solely for the sake of experiencing therapy, like in the old days when everyone had to be analyzed.""<BR/><BR/>I never met anyone like that, though psychiatrists in training might fall into that category, and perhaps patients who continue therapy well past a crisis. I'd still consider it therapy.<BR/><BR/>""therapy (or therapeutic interventions) can take place during a med check.""" That can work I suppose if the med discussion ends quickly and both are motivated or inclined to go into a psychotherapeutic mode. It's a pity in such a case that funds don't exist (I am guessing) for a longer session. On the whole it seems that a lot more psych services are needed than available.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-43268360004033185452008-11-20T21:31:00.000-05:002008-11-20T21:31:00.000-05:00Encounters of all types (15 minute med checks, cof...Encounters of all types (15 minute med checks, coffee with a friend definitely) can yield interesting revelations or life-changing insights, and many things, including chocolate, can feel 'therapeutic.' I do think that calling 'psychotherapy' requires regular meetings with certain boundaries and parameters simply by definition. I'm just not sure what the exact parameters are-- is a 20 minute session scheduled monthly a med check (90862) while a 25 minute session scheduled monthly a psychotherapy session (90805)? So, TP, I think we agree.<BR/>I'll add that not all psychotherapy is therapeutic! Ah, but I'm not anti-therapy at all (on the contrary) and I do believe it's extremely helpful to lots of people.<BR/><BR/>There are many types of psychotherapy and some of these impose fairly specific structures (eg the couch, or the structure of cbt, etc) upon the subject matter being discussed.<BR/><BR/>FooFoo5-- you lost me-- you believe it's a waste of training as a physician to have psychiatrists doing psychotherapy? Or did I misread? I think a lot of folk probably agree with this-- maybe it's own blog post.Dinahhttps://www.blogger.com/profile/09227988351623862689noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-42182355937794551942008-11-20T20:26:00.000-05:002008-11-20T20:26:00.000-05:00I found this to be a most fascinating exploration ...I found <A HREF="http://www.medscape.com/viewarticle/533620_1" REL="nofollow">this</A> to be a most fascinating exploration of "community psychiatry" and the role of the psychiatrist in the provision of services. I suspect that the "definer" of "what is therapy," for the practical purpose of fee-for-service, is and will be insurance companies for all but patients that can pay "out-of-pocket." And I emphasize "therapy" as a <I>billable service</I> and <I>therapeutic</I> as an action. Being directly affiliated with a major medical school, I could also argue, with some prejudice, that "psychiatrists of the future" have little to no practical training as "psychotherapists," and are increasingly inappropriate providers of "therapy" services. Could a psychiatrist "survive" as a "therapist" without providing 90862? With appropriate respect, psychologists & social workers do so. But <I>would</I> a psychiatrist do so? I believe that it would be waste of significant training and experience as a <I>physician</I>. As described in Irvin Yalom's <A HREF="http://www.amazon.com/Existential-Psychotherapy-Irvin-D-Yalom/dp/0465021476/ref=pd_bbs_sr_6?ie=UTF8&s=books&qid=1227230502&sr=8-6" REL="nofollow">Existential Psychotherapy</A>, pretty much <I>everything</I> we do, from the first call forward, is <I>therapeutic</I>, but the provision of "therapy" is a very different & distinguishable matter.FooFoo5https://www.blogger.com/profile/06459026418242101033noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-6295652937826197292008-11-20T15:25:00.000-05:002008-11-20T15:25:00.000-05:00I've been reading your blog for a while - this is ...I've been reading your blog for a while - this is a great post, as is the previous one on DSM v. <BR/><BR/>I've passed on the Kreative Blogging award to you, as I love to read your site.<BR/>Congratulations!<BR/><BR/>Head to http://healthskills.wordpress.com to see what I wrote - basically you list 6 things you love, then nominate six blogs for the award. It's fun, and creates some great links you might never have made before!<BR/>cheers<BR/>BronnieAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-57545903904067224092008-11-20T13:53:00.000-05:002008-11-20T13:53:00.000-05:00Good question - when does psychotherapy become psy...Good question - when does psychotherapy become psychotherapy? If you have a meaningful conversation with a friend over a cup of coffee, isn't that therapeutic as well? But that's not therapy because it's not structured as such (no therapist-client relationship for a start, although you may play that role with each other). I hear what you're saying about how a med check can be therapy but as a psychologist I would say there are degrees or types of therapy. Psychotherapy for me is predominantly a 'talking cure' structured over at least a few sessions which are regular, time-bound etc.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-37721707590060628792008-11-20T12:45:00.000-05:002008-11-20T12:45:00.000-05:00Hmm...I'm supposed to be having something that is ...Hmm...I'm supposed to be having something that is therapy, but it sure doesn't ever seem like it. Sort of the reverse situation.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-13948121857828150132008-11-20T08:22:00.000-05:002008-11-20T08:22:00.000-05:00These days, if a patient entered the ER with such ...These days, if a patient entered the ER with such complaints, there may be an unseemly scrum as psychiatrists from the surrounding area would converge in a minor melee to compete to provide services to this paragon of a patient.<BR/><BR/>Alternative universe SNL skit: Psychiatrist (gleefully throwing his prescription pad aside), thrusting one colleague behind him and knocking another to the floor, asks introspective, insightful patient on hospital gurney, "And how does that make you feel?"Novalishttps://www.blogger.com/profile/10501890494890617030noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-51206635790329293252008-11-20T07:05:00.000-05:002008-11-20T07:05:00.000-05:00When you say "and hopefully someone finds it helpf...When you say "and hopefully someone finds it helpful" it sounds like you have doubts on the helpfulness of psychotherapy? I mean, don't you regularly see how psychotherapy IS helpful to your patients? Or is it not that clear to you... I know you've posted in the past about wondering how a conversation about something mundane could be helpful.Jackiehttps://www.blogger.com/profile/17472517428832152273noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-19470053164047057082008-11-20T07:03:00.000-05:002008-11-20T07:03:00.000-05:00TP: It does seem surprising, but therapy (or thera...TP: It does seem surprising, but therapy (or therapeutic interventions) can take place during a med check. Roy has had this experience on his consult-liaison service, and I've written about it <A HREF="http://psychiatrist-blog.blogspot.com/2008/06/my-last-day.html" REL="nofollow">here</A>. People might say that's not psychotherapy even though my patients found it lifesaving. Talking about the price of beef might be life-saving, even if it's not exactly therapy. Go figure, at this point I say do whatever works.<BR/><BR/>I think the bigger question to ask is, do you consider it therapy when someone goes into therapy solely for the sake of experiencing therapy, like in the old days when everyone had to be analyzed. Do people even still do that anymore? Better yet, should insurance pay for it? (I know, those folks most likely pay out of pocket.) Just thinking out loud.ClinkShrinkhttps://www.blogger.com/profile/13316134491751195651noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-3466940292256781052008-11-20T03:17:00.000-05:002008-11-20T03:17:00.000-05:00I disagree with your concept that almost any conve...I disagree with your concept that almost any conversation with a psychiatrist counts as psychotherapy as long as the participants say it is so. Surely there must be an approach and methodology that is learned and followed which is defined as psychotherapy. Length ought to have some bearing as well; very short visit might be sufficient to check current mental state of the patient, but how much therapy could be done in 10 minutes or 15? or by a psychiatrist oriented towards and trained for drug prescribing?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-33218968895393748732008-11-19T23:31:00.000-05:002008-11-19T23:31:00.000-05:00""So a new patient presents with the usual chief c...""So a new patient presents with the usual chief complaint of: "I'd like to enter psychotherapy so I can better understand myself, my motivations, my patterns of behavior, and resolve any unconscious conflicts that may be hampering my ability to live life fully." Patient after patient, all day long.""<BR/><BR/>I was glad for the next sentence! ""no one has EVER presented (to me) with such a request"" because when I read that I thought...oh my Gosh! I did not present that way!! Ha ha ha!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-72319664889878016312008-11-19T22:00:00.000-05:002008-11-19T22:00:00.000-05:00From the best I can figure, if the psychiatrist ca...<I>From the best I can figure, if the psychiatrist calls it therapy, and the patient calls it therapy, then whatever transpires between the two is therapy, and hopefully someone finds it helpful.</I><BR/><BR/>Ahh yes, I totally agree. <BR/>Dinah, was it you who talked about your confabulated patient who talked about the price of beef for sessions at a time? - Yes it is, I just checked - a post from August 29, 2006 (I can't embed links - blogger is being, well, blogger) - but yes. Sometimes getting a handle on life can help abate symptoms. And sometimes just having a distraction for an hour can help too.Rachhttps://www.blogger.com/profile/11897760883997811787noreply@blogger.com