Compliance Conversations Podcast: All Things Therapy for Compliance Experts

Compliance Conversations Podcast: All Things Therapy for Compliance Experts

Posted by CJ Wolf
Jan 21, 2022 7:38:18 AM

Hello folks! In my most recent episode of Compliance Conversations, I sat down with a co-worker to chat about all things therapy. We cover a brief history and the evolution from the labs of folks like B.F. Skinner to the world of mindfulness and EMDR. We explain the difference between individual and family therapy and define the many types of therapy like talk therapy, humanistic therapy, and cognitive behavioral therapy. And, of course, we dive into the compliance risks associated with therapy, too (like how to avoid the wrong CPT codes and billing for more than twenty-four hours in a day).

 

Listen to this episode of “Compliance Conversations with CJ Wolf: All Things Therapy and Compliance Risks” for free on Soundcloud or iTunes. It’s the perfect length for a work commute. You’ll find the transcription below. Enjoy!

 

 

 

Thanks so much for listening. Have questions or comments? Put them in the comments below!


Episode Transcript

CJ: Welcome everybody to another episode of Compliance Conversations with Healthicity. I am CJ Wolf, and today we are going to be talking about psychotherapy, or what most of us refer to today as just therapy. And so, we are excited to share this with you today. We are going to have our wonderful colleague Misty asks me some questions. Some of you may know that before I turned to a full-time career in compliance, I was studying psychiatry, so I had gone to medical school and completed medical school and began a residency in psychiatry. I am not a licensed psychiatrist today. It’s been over twenty-some years, but it’s an area that I did study a bit, so we're going to talk about some of these things, and we’re also going to relate them to compliance a little bit. So, welcome, Misty.

Misty: Hi CJ. Thank you very excited about this.

CJ: Yeah, I think it’s a good topic, and you know I’m thinking back on my history. Twenty-some years ago, therapy was a little more, you know there are still some social stigmas a little bit. But nowadays, I think going to therapy is a little more common, and people are a little more willing to talk about it and the benefits and all those sorts of things. So I think our podcast today is going to be a good one for folks.

Misty: Oh yeah, one hundred percent (100%). I said it before on the last podcast. I’m a millennial, so I don’t know anyone who isn’t in therapy [laughs].

CJ: Right? [laughs] Exactly, it can really help. To me, it’s kind of like exercises for your mind. We do exercise, we watch our diet. People go to physical therapy, like if they had a stroke and they need to now relearn to use their arm or whatever kind of injury or surgery, and now they’re doing physical therapy. Psychotherapy is kind of like mind therapy, if you will.

Misty: Oh yeah, one hundred percent (100%), and they’re so connected, the body and the mind.

CJ: Yeah, it’s kind of like the mind is the last frontier in medicine. We know from a physiological standpoint how the heartbeats. Like what prompts it to beat, how the pressures are created, you know we use the physics and physiology and can figure that out. The mind is still kind of the last frontier. We know that it’s there. We don’t know exactly how it works. It’s so complex, but we know that that interaction is there between mind and body.

Misty: Yeah, totally and like you were saying about stigma and how that’s changed. A lot of that is also because psychotherapy has changed.  So I wanted to ask you:

  • Question: What is psychotherapy, and what does it look like?
  • How has it changed over the years?

Misty: I don’t know if anyone else out there is like me, you might be thinking back to old school, scary psychotherapy.

CJ: Exactly, so psychotherapy, or we can even just call it therapy. It’s a combination of science and art. A skillful clinician can help people make changes and healthier choices. Minimizing destress and minimizing dysfunction, similar to how a physician might help someone who has diabetes. How do you minimize the effects of this underlying disease so that you don’t have additional side effects and that you can have as healthy a life as possible while living with this condition? Not everyone who goes to therapy has some sort of severe mental illness, but we all go through periods of time where we might have depression or stress, or anxiety. Some people do may have more severe types of conditions like bipolar and some other things where medicines might help, but psychotherapy is more the talk therapy. It is how we work with the mind. You’re absolutely right Misty. It has changed significantly. A lot of us think of the psychologist or psychiatrist sitting in a chair and the client or patient lying on a couch. They are talking about their dreams and those sorts of things. That’s actually where psychotherapy started a little bit. Think of Sigmund Freud, Carl Jung, these individuals, that is called psychodynamic perspective or psychodynamic therapy, or psychoanalytic psychotherapy or psychoanalysis where you’re kind of talking about how the person, their past and their development, did they have some sort of crisis, you talk about the subconscious and conscious types of things. That is a type of psychotherapy, and that is what a lot of us have in mind but there are so many theories and so many different modalities for psychotherapy. We’re going to talk a little bit about those. In general, to answer that first question, what is psychotherapy, it is mind therapy, and it is talk therapy and helping us deal with distress and dysfunction.

Misty: Yeah, before I ever went. When I was younger, whenever someone mentioned therapy, I immediately thought of those kinds of 70s horror flicks. They really loved that theme in the 70s, and I was like, I don’t want to do that but no, definitely not the experience.

  • Question: What are the main types of psychotherapy or therapy, as we’re going to call it, moving forward?
  • What does each type of therapy entail, how is it done, all of that.

CJ: Yeah, so, let me address that in two paths. I’ll talk about the easy path first, and then the other path we’ll get into the types a little bit. I’m going to break it up a little bit first into the format and then the type of therapy.

First, let’s talk about format because the format can apply to all types of therapy. When I say format, I’m talking about how it is delivered, who’s in the room, those sorts of things. So we have individual therapy. That’s what most of us think of where it’s just the psychologist or psychiatrist, the social worker, whoever is doing the therapy, and then the client or patient. That’s called individual therapy. There’s also family or marital therapy where it’s the therapist plus maybe a couple, a married couple, or a couple that is having relationship issues even if they’re not married and they are trying to work through those relationship issues with this independent third party. So that’s another type of format that’s who's in the room. Related to that is family therapy, and you can do family therapy with the family or without. Let’s say there’s a teenager that’s struggling with some sort of issue, and that teenager may go to individual therapy, but then there may be family dynamics that are contributing to the destress, so there may be family therapy. So the therapist meets with that teenager plus the parents or somebody else, maybe it’s a guardian or somebody, but then in family therapy, you can also have the parents meeting with the parents without the teenager as well. Now the teenager knows this, and they’re talking about different things. That’s another type, and the third major format is group therapy. Group therapy is when you have multiple individuals who may be having similar struggles in a room, and you have the therapist leading group activities, sharing supportive techniques, those sorts of things.

Misty: That’s kind of like AA [Alcoholics Anonymous], right?

CJ: Yeah, exactly. That would be a form of group therapy. You can do group therapy with people who are struggling with substance abuse, or another example might be individuals who recently lost a spouse or child to death. So they are sharing similar grief, so you’re trying to work through that together. When I say formats, we’re talking about who’s in the room. We’ve talking talked about individual, marital, and family. I’m kind of putting it into one and then group because, in group therapy, the people aren’t related. They’re not strangers because they’ve been in the group together. So those are formats.

The other part of your questions was what the types of therapy are. So let me name them, and then we can walk through these. So the first one is psychanalysis. I mentioned it a little bit already. That’s where Freud started, and you’re looking at the past and development and conflicts, and maybe you had a crisis or trauma, crisis, and subconscious, so that’s called psychoanalysis. And this is historically how different forms developed, which may have been one of the earliest types. In response to that, some people didn’t believe that was the full story. People like B.F. Skinner with behavioral therapy and behavioral modification. So psychoanalysis, behavior, then you have client-centered, it’s sometimes also considered person-centered or humanistic therapy, so that’s the third type, and then a fourth type is a cognitive therapy. Now, these are the major types. There are hundreds probably because you can have different theories, different approaches, as I mentioned this is both science and art, the mind is not one hundred percent (100%) understood, so there are lots of approaches lots of different ways to deal with therapy. We wouldn’t have time to cover every possible type of therapy. I don’t even know if there’s a text or literature that covers everyone because it develops so quickly, but those are the four major types.

So you mentioned could I go through what each one is, so let’s start with psychoanalysis, or psychodynamic is what it’s sometimes referred to. So this goes through someone’s past and their development as well as ways that developmental crisis and themes from the past keep repeating themselves in the person’s current relationships and functioning. It also focuses on all the needs and the drives that constantly push and pull us. The reason it’s sometimes called psychodynamic is that you have these dynamics in your life, these desires, these drives, these needs, and they’re pushing and pulling, and there can be varying levels of awareness of these things. Some are conscious, and some are subconscious, and those can sometimes create conflict within us, so psychodynamic or psychoanalysis, the thing of Freud and Carl Jung, the goal here is to develop what’s known as resistance and transference. I don’t want to get too technical here but basically, what this means is you’re using different techniques and psychodynamic models. The therapist does design to reduce the resistance and promote transference. What that means is pushing those issues and problems onto the therapist. So the therapist acts as a transference object where the patient or client can put those problems on the therapist, and that provides insight for the individual and catharsis, which is a cleansing type of thing. So that, though, when it first started in the traditional role was typically daily sessions over the course of several years. You can imagine how expensive that is and how intensive that is. So that’s why that hasn’t really stayed. There are people who still do it, but it’s limited because people don’t have the time or the money to do that sort of thing. So it’s developed over the years.

Misty: Yeah, I was going to say that’s a whole level of that access conversation.

CJ: Yes, exactly right. We did a podcast recently with a psychiatrist colleague of mine, and we were talking about access and how hard it is just to get in to see somebody. Even when you’re having a crisis or a lot of people just have to go to the emergency room to access psychiatric care these days. So that, to your point, Misty is right. It’s like, how do you do that.

Misty: Yeah, you would have to wait until like a patient either quit or passed away before you could see somebody.

CJ: Right, and people who do the kind of traditional Sigmund Freud approach it’s very expensive, so most people can’t afford the kind of like daily, multiple sessions over the years. Okay, so that is not as common nowadays.

So the second type that I mentioned is behavioral therapy. The other thing I should mention is sometimes. These therapies are mixed. So we are going to talk about behavioral and cognitive therapy, and some people do cognitive behavioral therapy, so I’ll mention these two, and then you can imagine how those two might mix. So behavioral therapy was historically the next major movement, and B.F. Skinner was one of the major individuals who promoted and designed it. It’s sometimes also called behavioral modification. So behavioral therapy or behavioral modification because the focus is not so much on your subconscious and conscious and poles and crisis and psychological injuries, it’s more we’re scientists, we’re going to do x, y, and z and see if behavior changes. Sometimes this is just called behavior therapy. Really here, the therapy relationship in place of psychodynamic, behavioral psychologists put very specific, very systematic applications, kind of based on classic and operative conditioning such as systematic desensitization. You’ve probably heard of Pavlov, so he was a behaviorist. So Pavlov’s dogs, you probably heard of where a bell was rung or sound, and then they would be given a treat, and then they would just ring the bell, and then they would salivate because they’ve been trained this operative conditioning. So that’s what behavioral therapy is; it’s trying to change a behavior you do that through different techniques. One is desensitization, so let’s say someone has an irrational fear of large crowds. And that’s a real condition. It affects their lives. They can’t go to social events, enjoyable events that they might like and those sorts of things, so people want to help solve that. In behavior therapy, what they might do is slowly introduce you to larger and larger groups, and while you’re dealing with that emotional dissonance, you provide support to that individual. So rather than throw the person into a large crowd on day one, it might be let’s just go someplace where there are three people, we’re going to go to a coffee shop with three people, and then we’re going to go to a classroom where there’s this many people so it’s kind of this desensitizing approach where over time you try to change the behaviors and you’re monitoring is this person having a panic attack while they’re doing this and what can we help this person focus on so they don’t have those physiological symptoms and those sorts of things. So Behavior therapy is you’re trying to change behavior.

Misty: That’s often called exposure therapy, right, where you’re exposing yourself?

CJ: Right, exactly.

Misty: And some of the behavior therapies. So in my experience, some of the things a therapist will have you do are even just change your self-talk, like the way that you talk to yourself, like reminding yourself this is anxiety, it’s a liar, I’m fine, and it’s something as simple as that can make a huge improvement if you have anxiety.

CJ: Absolutely, and what you just brought up is basically cognitive therapy. That’s why a lot of people combine them together and call it CBT or Cognitive Behavioral Therapy because they go together. We speak behavior therapy in its strictest sense. We’re not so much concerned about the mind; we’re just concerned about how we can get the behavior to change. But that strict behavior therapy can be difficult, so Misty what you just talked about with the self-talk and that’s the cognitive piece, and so cognitive therapy was developed by people such as Aaron Beck, Ben XYZ, and Ellis. Basically, they developed methods of dealing with maladaptive thought patterns. So sometimes our self-talk is something such as “I’m no good” or “I’ll never be a success” or those types of things that are coming from yourself over and over again that cause some type of emotional distress or some other dysfunctional behaviors. So think of cognitive as cognition, how the mind thinks. So cognitive therapy is how the mind thinks, and you’re trying to teach yourself, just like you said, Misty, of positive self-talk or to avoid these negative thoughts over and over again.

Misty: Yeah, it’s called “Name it to tame it.” [laughs]

CJ: There you go. And you’re kind of getting in connection with, “Oh when I have this thought, this is the emotion that arises, or when this emotion rises, it leads me down this pattern of thought that is not productive and cause me more distress or more dysfunction.” Sometimes those can be illogical self-statements as well. Sometimes they may be based on history and your past experiences, but sometimes they can be illogical completely. And so that’s why cognitive therapy is often combined with behavioral, so you may see people documented as we did a behavioral therapy session of “XYZ” or we did CBT, cognitive-behavioral.

The other one that I had mentioned is known as client-centered, person-centered, or humanistic. This focuses on individual growth and maximum potential. Some of the psychologists who promoted this were Carl Rogers, Abraham Maslow; these are the individuals that talked about the needs of individuals. So you have basic needs; we have basic needs to have food, warmth, safety, and love. There are many studies done in homes, orphanages, and things where babies and not been held, and just that physical holding and touch and love have a physical effect on babies, and they can have failure to thrive if they don’t have that touch and that love. This client center, humanistic focuses on individual growth and maximum potentials, and then the therapy part is supporting and understanding that a lot of people lack in their daily lives certain things to help achieve their goals. So this client-centered humanistic focuses on being in touch with your feelings, with honest communication, points of emphasis, the clinician or therapist will do things such as provide empathy and active listening. So that’s actually part of therapy is the therapist is providing empathy and active listening, and that can be helpful to the client or patient. And then, the client or patient can then realize their potential, be more accepting of themselves of others, and generally be more at peace with the world around them.

As you can see all of these, you’re probably like, can they be mixed? And they absolutely can. I’ve kind of just outlined the psychoanalysis, the Freud, behavior therapy, kind of B.F. Skinner, client-centered or humanistic and then cognitive. So those are the four main thoughts, and you can approach them from very strict standards where you don’t go outside of the boundaries of those therapies or what happens more today is these get mixed, and you use multiple techniques throughout the therapy sessions. That’s a long answer to your question [laughs].

Misty: No, it was fantastic. It was very thorough, which is awesome. I was going to say, from my experience, just from chatting with friends, it sounds like it’s all just mixed, and some of the things seem to rely on each other now. Like if a person does EMDR therapy, which is kind of a way of reprogramming your subconscious, you have to start with talk therapy first, and then they identify all of the things that historically might be causing behaviors, and then you do the EMDR, which is essentially like these little buzzers in your hands that go back and forth and mimic the REM sleep I think. Is that right?

CJ: Yep.

Misty: And then after that then there’s like a cognitive-behavioral component on top of it. I feel like it's very thorough now. They’re like, let’s just do it all.

CJ: Yeah, and you know, as I mentioned, the mind is the last frontier in medicine, so there’s lots of research being done and, just as you mentioned Misty, different therapists are trying to combine and say, okay, I’ve done this kind of therapy of years but what if I added this piece, would this actually show benefit. So they actually do studies where people actually can improve. There are even studies, for those of you listening who are like all of this is hooey, there are studies where they studied people with cancer, and these were people that were terminal, so they were going to die relatively soon. One arm of the study just had traditional chemotherapy, physical medicines, and those sorts of things. The other arm had the same medicines and the only thing that was different was they added supportive group therapy. Those people lived longer. The people who had supportive group therapy so statistically it was shown.  I mean, these are studies where the only difference between those two different groups and those treatments they got was one had a supportive therapy group. They all eventually will die, but one group lived longer. Well if you were a drug company and you had a drug that helped somebody live six months longer then the drug would sell, right? It would be a very important drug because it would give people six months more of life. So this supportive therapy actually had an effect on the body and it actually prolonged life, and so those are important things to think about just in general.

The other thing you were mentioning, kind of brought up in my mind the four stages of therapy. When you go to a therapist on day one, you don’t jump into certain things. Stage one is kind of the introductory stage and you build a report with the therapist. The second stage is when you start setting goals. So it might be like, look, this is holding me back, and I want to do “XYZ” in the future, so you kind of set goals. The third stage is where you really focus on the intervention. You’re changing problematic thoughts, you’re changing behaviors, you’re changing feelings, and then the fourth stage, you evaluate what’s been going on, and you actually want to terminate the relationship at some point. You want to demonstrate that the patient, I mean that’s the biggest compliment to a therapist, is when the patient doesn’t need to come back and see you anymore because they have learned now to function independently. Those are the four stages. When you were talking about the EMDR, it reminded me of those stages of therapy.

Misty: Yeah, I was going to say for anybody listening who has thought about therapy or tried it and just wasn’t into it, I think the first stage is where people often fall off because they go, well, I’m talking to this person about all this stuff, and I’m not getting better, and nothing is happening. It takes a long time. One, you have to make sure it’s the right therapist for you.

CJ: That’s right, and there’s nothing wrong with going to a different therapist. It just might not click. It’s kind of like dating. You’re a very nice person, and no offense but this is just not going to work.

Misty: Yeah, and they can be amazing for one person and terrible for another just because their personalities don’t match well. But that introductory period, I think is really frustrating especially if you have been struggling for a long time and you finally decided to go so just hang in there. If you feel like you mesh well with the person, hang in there. Like CJ said with the stages, just wait until you get to stage two. I was going to say CJ, I don’t know if you have read The Body Keeps the Score by Bessel van der Kolk. He’s a psychiatrist who worked in all kinds of different organizations and facilities and he wrote this amazing book about all of this research he and his team, some of the best in the world, did on how trauma affects peoples bodies and he talks about chronic fatigue and all of these things and how they know there’s a connection if you haven’t healed your past it’s going to deteriorate your body. It’s an amazing book.

CJ: Right, and I often use this example for people who don’t believe in the mind-body connection. I hike a lot, so I’m out in the wilderness, and I’m walking down a trail and, this actually happened to me last Fall, I got a little lost and I was in Grand Teton National Park, and I ran across a pack of wolves. I was actually excited, I had my camera, and I was trying to take pictures of wildlife but just me seeing the wolves. So nothing changed in the environment. The temperature didn’t go up, it didn’t all of a sudden become windy, and the barometric pressure didn’t change. All I did was visually see the wolves, and my heart rate started to go up. Well, that is a fight or flight type response, and so the mind interprets what it’s seen, and it changes your body physiologically. So there absolutely is this connection so if your mind is constantly having those types of things, and this is just one example, it can put stress on your body and it releases hormones and does all sorts of things and can absolutely have a physical affect-based off of something you’re thinking or seeing or interpreting.

Misty: Yeah, one that’s amazing. I can’t believe you saw wolves because I’ve been going to Yellowstone every year for years trying to see them, and they are evasive and impossible. That’s amazing. And two, yeah, your cortisol levels can get permanently reduced to where it can’t even help you manage stress anymore, and you’ll just be anxious forever because of something like that. Or the new talk about epigenetics, where unhealed trauma can imprint into your genetics and actually affect your kids. It’s just crazy stuff now, but it’s so cool.

CJ: And I’m glad you shared the title of that book because it reminded me a lot of what I’m sharing about these different types of psychotherapy. It’s not my own original thought. I was referencing a book called, “21st Century Psychology,” it’s a Reference Handbook, and it’s like a giant textbook, and Chapter 86 is all about psychotherapy. You can imagine how many chapters there are here. But that’s a really good book. The author was Michael Leftwich is the who wrote this particular chapter on psychotherapy, and it was edited by Davis and Buskist, anyway, if you’re interested.

Misty: Yeah, that sounds like a very thorough and amazing resource. And we will put them in the show notes, too, folks, if you need them. And CJ just to give some advice at the end:

  • Question: Do you have any advice for folks on finding the right therapy for themselves?
  • Should they do research going into kind of know what they’re looking for or just assume that everyone is doing a mixed approach now?

CJ: Yeah, that’s a good question. I guess my advice would be; don’t be afraid to shop around. Meaning, like you said, if you go someplace and you say you know therapist, this is not really what I anticipated. I was looking more for this. They can maybe share other resources. The other thing that you might consider, a lot of employers nowadays have what are known as EAP programs, employee assistance programs, where they offer usually a clinical social worker one or two sessions for free. If you talk to your HR department and say do you guys have an EAP program? An employee assistance program, they usually, it’s all confidential, and when you’re doing that, it’s also a time to explore the therapies that might be beneficial.

Misty: Yeah, that’s good advice.

CJ: Yeah, I think that’s a really, don’t be afraid to jump around, be like this isn’t really what I thought. Ask people, ask therapists what other kinds of therapy might help me. That’s worth it.

Misty: Yeah, definitely, and tell them if it’s not working too. Like, I feel like I’m not getting anything out of this. Remember that they’re working with and for you. And then, as our expert compliance officer, CJ.

  • Question: What are the compliance risks associated with psychotherapy? For all of the psychotherapists or therapists out there who might be listening?

CJ: Exactly, we are a compliance conversations podcast, so we have to talk about compliance. So just a few things quickly, when it comes to coding and billing, you have to realize first of all that a lot of payers have payment limitations, so they might only authorize a certain number of sessions. Sometimes doctors and therapists are like. This is really working. I need to keep getting paid to do this, and they might code it with something different, like they might pick a different procedure code even though it’s really the same thing they’ve been doing. That’s when you start to get into this world of false reporting. You’re reporting CPT codes of things that you didn’t actually do. And most of us won’t do that. The other thing that you can run into trouble with, this is usually not intentional, but you got to remember these psychotherapy codes are time-based codes, and you can also do psychotherapy with an evaluation and management service. There are different codes depending on what you’re doing, so time-based it might say psychotherapy thirty (30) minutes and the next code is psychotherapy forty-five (45) minutes? Well, what if you did psychotherapy for thirty-seven (37) minutes. Well, if it’s thirty-seven (37) minutes, you have to round down because the difference between thirty (30) minutes and forty-five (45) minutes is fifteen (15), you have to go over the fifty percent (50%)  mark. So if you did thirty-seven (37) minutes, you’re under that threshold, and you report down, so you only report the thirty (30)minute code. If you did thirty-eight (38) minutes now, you’re over the halfway mark to the forty-five (45) minutes, so you’d report up. You could round up, and you could report the forty-five (45)minute code. So time-based is important.

The other thing that I’ve seen when I’ve done document reviews and audits and those sorts of things it’s really important to say what the goals are. So you might have a therapy plan. So on day one, visit number one, the clinician says, okay, this is why the person is here; we think this therapy is going to be best, we think this can be accomplished in so many sessions, and there are going to be our milestones and our goals. It’s important and subsequent visits to be documenting, “Okay, we’re thirty percent (30%) towards our goal,” “we’re closer to our goal,” or “we’re not progressing towards our goal.” It’s important to document progress in each subsequent visit and are getting closer to those goals.

The other thing I’ve seen enforcement on and people get in trouble with this all the time is they do group therapy where you have fifteen (15) people, and the therapist spends an hour and a half with that one group and then that therapist bills individual psychotherapy codes for all fifteen (15) people. Well, you didn’t do individual, you did group therapy, or you did family therapy, and so a lot of times they want to report those individual psychotherapy codes because the therapy was good for the individual, but the codes are based on what you did. When I outlined those different formats, the codes follow those formats. Individual, those there are psychotherapy CPT codes for the individual. There are therapy codes for family, and in the family codes, there are different codes, one code for the client, the child, or the person who is also present with the family, and there’s a family therapy code where that individual is not present, and then there’s group therapy. It all comes down to reimbursement. Group therapy might not reimburse for what individual therapy for fifteen different people would do. One other area where I’ve seen people get in trouble is known as impossible days. What that means is there are only twenty-four (24) hours in a day, and there have been some people who have gotten in trouble because they’ve billed codes for more than twenty-four (24) hours in a day, and it’s like that’s impossible, or they’ve come close to that. They’ve billed for twenty (20) hours of therapy in one calendar day, but they were only in the clinic for eight (8), so how is that possible. You got to be really careful because these are time-based codes.

Misty: Yeah, wow, that would be a hard one to argue that you worked more than twenty-four (24) hours.

CJ: Yeah, exactly, and even the ones where it’s not a full twenty-four (24) hours like they billed twenty (20), and then they can document that you also went to the nursing home. You were seeing patients there, so how is it possible that you did twenty (20) hours when you weren’t even in your clinic for this many. You got to be careful there, and then the last thing I would say is that diagnosis coding is also important. Those are the ICD-10 codes. You got to make sure those are accurate for what you’re doing. There are some psychotherapy codes for crisis management, and if that’s the case, then you want to make sure your diagnosis codes show that the patient was in crisis. So not all mental health and not all psychotherapy services are crises. A crisis is when the patient might harm themselves or harm someone else. Those are more crises mode types of things, and the diagnosis code should reflect the severity of that event. Most mental health services, you’re not in crisis, right? Yes, you have conflict, and you have distress and that sort of thing, but you’re not so severe that you’re at risk for self-harm or harming others. So diagnosis coding is also important.

Misty: Fantastic, that’s all great information, CJ, and really interesting on-the-time stuff.

CJ: Yeah, exactly, and that’s because those codes are based on time, and you have to document that in the record, so don’t forget to do that. So don’t just for off of your schedule for the day, put in the clinical record, “I saw Mary Jones, we did supportive psychotherapy or cognitive psychotherapy.” So mention the type that you did, mention the techniques you used, and you say we did this for thirty (30) minutes. That’s the kind of thing you need to have in your documentation.

Misty: Awesome. That’s fantastic, CJ. Thank you so much. This is all so good.

CJ: Yeah, interesting stuff to talk about for sure.  Misty: It really is fun, and folks, don’t forget we’ll put everything in the show notes. For the books that were mentioned, we usually add additional resources, so you can find all of that there.

CJ: Yeah, and thank you, Misty, for asking me some questions and turning the tables a little bit. We’d like to thank everybody who listened to this episode, and we hope you listen to another episode of Compliance Conversations soon. Thanks, everyone.

Misty: Thank you, CJ bye.

CJ: Bye, everyone.

Questions or Comments?