Is doing therapy as a psych NP realistic?

What Members Are Saying (AI-Generated Summary)

Members are discussing the time required for medication management appointments, with some stating that the standard 20 minutes may not be necessary for all cases. They also talk about the financial aspects of different appointment lengths and codes, as well as the potential for nurse practitioners to provide therapy along with medication management. Additionally, users are sharing their experiences and perspectives on balancing therapy and medication management in their practice.

Im considering pursuing my psych NP but I know most psych NPs are med management focused and I would really want to incorporate a lot of therapy into my practice, I was wondering if this is a realistic goal? 

Specializes in Psychiatric and Mental Health NP (PMHNP).
16 hours ago, MentalKlarity said:

It is not, however, the norm. Prospective PMHNPS should understand that the vast majority of employers will utilize the 15 min med management appt. That's a stressful way to practice and you basically have time to just go over meds and prescribe and nothing else. If they ask you to bill add on therapy in that time it's unethical and fraudulent.

It appears to be the norm to bill for supportive therapy - I do 20 minute follow up appts and that is enough time for basic supportive therapy.  

Specializes in Psychiatry.
2 hours ago, FullGlass said:

It appears to be the norm to bill for supportive therapy - I do 20 minute follow up appts and that is enough time for basic supportive therapy.  

That leaves 4 mins max for med management so it's easy to fall behind.

Specializes in Psychiatric and Mental Health NP (PMHNP).
53 minutes ago, MentalKlarity said:

That leaves 4 mins max for med management so it's easy to fall behind.

We specify how much time on therapy - I can do about 11 to 15 minutes.  

Specializes in Psychiatry.
40 minutes ago, FullGlass said:

We specify how much time on therapy - I can do about 11 to 15 minutes.  

Ah, okay. What add on code allows 11-15 mins or do you not do an add on code?

Specializes in ICU, trauma, neuro.
MentalKlarity said:

Ah, okay. What add on code allows 11-15 mins or do you not do an add on code?

I use 90833 which requires at least 16 minutes of therapy.  I do 30 minutes appointments. Most of the insurances that I take pay anywhere from $75.00 to $125.00 for this add on code on top of the 99214 or 99213.

myoglobin said:

I use 90833 which requires at least 16 minutes of therapy.  I do 30 minutes appointments. Most of the insurances that I take pay anywhere from $75.00 to $125.00 for this add on code on top of the 99214 or 99213.

Specializes in Psych/Mental Health.

Where I worked we don't do add-on because the appts are booked for 15-min (though realistically we spend 20 min). It's done that way because there's a huge need for psych prescriber and there's a large in-house behavioral health therapist group. If PMHNPs do 30-min f/u, the wait list will probably double (6-months). Not to mention, >90% of patients are on medicaid so a 90833 would add $10?

This isn't to say that we don't do supportive therapy with CBT/DBT/MI techniques. Anyone with some psych RN experience almost always do some of these skills by default. Is that really doing a lot of psychotherapy? That's subjective.

Specializes in Psych/Mental Health.
3 hours ago, FullGlass said:

We specify how much time on therapy - I can do about 11 to 15 minutes.  

The minimum requirement is 16 minutes and E/M must be based on MDM. I think if your appts are booked as 20-min and you're billing a lot of add-on, there's an increased risk of audit (from what I've heard).

Honestly my experience is that 4 minutes is rarely enough to go over meds...but the patients I have often have complex of med/psych/SUD conditions. 

Specializes in Psychiatry.
myoglobin said:

I use 90833 which requires at least 16 minutes of therapy.  I do 30 minutes appointments. Most of the insurances that I take pay anywhere from $75.00 to $125.00 for this add on code on top of the 99214 or 99213.

Same. I enjoy it. I get to spend more time with patients, don't feel as rushed, have half as many notes to complete and make the same or more than if I was trying to do 15 min med management 4x an hour.

Specializes in ICU, trauma, neuro.
14 hours ago, MentalKlarity said:

Same. I enjoy it. I get to spend more time with patients, don't feel as rushed, have half as many notes to complete and make the same or more than if I was trying to do 15 min med management 4x an hour.

Also my "cash rate" is $150.00 for a 30 min medication management appointment and $250.00 for a 90 minute intake. In these situations I also provide therapy but it is  "lumped in". About 10% of my patients pay cash.

Specializes in Psychiatric and Mental Health NP (PMHNP).

We use 90833.  I do not see how med mgt takes a full 20 minutes unless the pt is very complicated.  This is an outpatient practice and the most common issues are anxiety, depression, PTSD, ADHD, bipolar d/o.  If the pt is stable and doing well, how does med mgt require 20 minutes for simply something like Lexapro?  It doesn't.  How is your mood?  Good.  Sleeping well?  Yes.  Appetite?  Normal for me.  Anxiety?  Not any more.  Any troubling SE?  No.  That does not take 20 minutes.

Specializes in ICU, trauma, neuro.
1 hour ago, FullGlass said:

We use 90833.  I do not see how med mgt takes a full 20 minutes unless the pt is very complicated.  This is an outpatient practice and the most common issues are anxiety, depression, PTSD, ADHD, bipolar d/o.  If the pt is stable and doing well, how does med mgt require 20 minutes for simply something like Lexapro?  It doesn't.  How is your mood?  Good.  Sleeping well?  Yes.  Appetite?  Normal for me.  Anxiety?  Not any more.  Any troubling SE?  No.  That does not take 20 minutes.

I usually take my whole 30 minutes. I will usually do a PHQ, GAD-7 and an ADHD V1.1  or Yale Brown if relevant.  I will spend time reinforcing things like CBT-I, balance exercises (such as those supported by Dr. Hallowell in ADHD 2.0), gratitude journaling, supplements like Omega three fatty acids, DASH diet (which has a recent study supporting ADHD, but is also useful in addressing hypertension that can be an issue with ADHD meds).  I will talk about Podcasts like Dr. David Puder's Psychiatry and Psychotherapy Podcast and encourage clients to participate in the "book of the month club" (this month it is Victor Frankl's "Man's Search For Meaning" and his "logos therapy".  Honestly, I could use more time than 30minutes much of the time.  

Specializes in Psychiatric and Mental Health NP (PMHNP).
On 5/19/2021 at 3:07 PM, myoglobin said:

I usually take my whole 30 minutes. I will usually do a PHQ, GAD-7 and an ADHD V1.1  or Yale Brown if relevant.  

Yes, my point is that just the med mgt doesn't usually take the whole 20 minutes.  I use the rest of the tiime to provide supportive therapy.  A lot of patients tell me they just want someone to talk to, and that alone provides them with a lot of benefit.

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