Practice Lab Diagnostics

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Problems Domain

What MDM complexity level does this scenario represent?

Low Moderate High

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← Layers

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Which basis are you using?

MDM Time

Select the most defensible code:

99213 99214 99215

Next scenario →

Unit 1 — Psychotherapy Documentation

Guided Learning

Each unit introduces a concept, forces a decision, and hands you off to the mode that drills it.

What actually supports 90833?

Psychotherapy: Supportive therapy provided addressing ongoing anxiety and recent work stressors. Discussed coping strategies and encouraged use of grounding techniques. Patient engaged and receptive throughout session.

Would this support 90833?

Yes No

See why →

Psychotherapy: Supportive therapy provided addressing ongoing anxiety and recent work stressors. Discussed coping strategies and encouraged use of grounding techniques. Patient engaged and receptive throughout session.

Most 90833 problems don’t come from no therapy — they come from therapy that wasn’t documented clearly enough to defend it.

A defensible note — built line by line

Why does separation matter? →

Two sections. Two jobs.

These serve different parts of the claim.

If you bill a psychotherapy add-on, E/M must be selected by MDM — not total time.

Two notes. Which supports 90833?

One more variant →

Would this support 90833?

Psychotherapy: Provided CBT, DBT, and supportive therapy addressing anxiety, mood instability, interpersonal stressors, and trauma-related symptoms. Reviewed multiple coping strategies, safety planning, and emotional processing techniques. Patient actively engaged, receptive, motivated, and demonstrated insight throughout.

Yes No

Now you build one →

The pattern is always the same.

Build it yourself

Generating scenario…

Grade my note →

Continue →

Now apply it across real scenarios.

You have the pattern. Psychotherapy Documentation Mode drills it across six recognition scenarios, classification problems, and note builds — until the judgment is automatic.

Go to Psychotherapy Documentation Mode → Start Unit 2 — MDM vs Time Try another example Return to Practice Lab

Lesson 1 of 7 — Two pathways

Read this note. There are two valid ways to bill it.

Lesson 2 of 7 — Choose the higher level

Same visit. Two pathways. You can only bill one.

Task — Pathway decision

Which basis would you use to bill this visit?

MDM Time

Continue →

Lesson 3 of 7 — Psychotherapy constraint

Same visit. Psychotherapy is documented — and you are billing it.

Task — Claim decision

Given this visit, what would you bill?

The psychotherapy section is documented and you are billing the add-on. Both options below include 90833.

99215 + 90833 99214 + 90833

Continue →

Lesson 4 of 7 — Low MDM doesn't trap you

No psychotherapy billed. Time is available again.

No add-on → no restriction on time-based E/M.

Follow-up for generalized anxiety disorder. Patient reports stable symptoms with no recent exacerbations. Denies significant anxiety or functional impairment.

Continues current medication regimen without issues. No changes made today. No psychotherapy performed.

Total time on date of service included evaluation, medication review, and documentation, totaling 34 minutes.

Task — Highest supported code

What is the highest defensible code for this visit?

99213 99214

Continue →

Lesson 5 of 7 — Problem count doesn't determine level

Two diagnoses. But what does MDM actually support?

Established patient seen for follow-up of MDD and GAD. Reports stable mood and minimal anxiety. PHQ-9 score 5, GAD-7 score 4, both consistent with prior visit. No significant changes in symptoms reported.

Current medications continued without change. No psychotherapy performed. No new concerns raised.

Time on date of service included evaluation and documentation, totaling 24 minutes.

Task — MDM evaluation

What does MDM support for this visit?

99213 99214

Continue →

Lesson 6 of 7 — Time requires documentation

A long visit is not the same as a time-based claim.

Now that you've seen what limits MDM, the question is: can time be used instead?

Patient seen for follow-up of MDD. Reports improvement. Medication continued unchanged. Visit was lengthy due to patient questions about side effects and long-term prognosis. Provider spent significant time educating patient and documenting the encounter.

No psychotherapy performed.

Task — Documentation recognition

Can this provider bill by time?

No Yes

Continue →

Lesson 7 of 7 — Time can dramatically outperform MDM

Same visit. See what each pathway actually yields.

Established patient presenting for follow-up of MDD and GAD. Reports stable mood and minimal anxiety. PHQ-9 score 5, both conditions stable, no changes in symptoms since last visit.

Current medications continued without change. No psychotherapy performed. Extended time spent on patient education, answering questions about long-term treatment, and documentation.

Total time on date of service included evaluation, patient education, and documentation, totaling 42 minutes.

Task — Final billing decision

What is the highest defensible code for this visit?

99215 (time) 99213 (MDM) 99214

Finish →

Unit 2 complete

The framework.

You don’t pick the higher code.
You pick the method that’s allowed — and then document it.

Start MDM Foundations → Try another case variant Return to Practice Lab

Need help?

Stage 1 — Practice Setup

Before you see a patient, your system has to be configured.

Your patient today: Dana Reyes, established patient. Telehealth follow-up for MDD and GAD. Premera Blue Cross. You'll follow this case through every stage of the billing cycle.

Every claim you submit inherits settings from your practice configuration. Errors here cascade forward — wrong POS code, wrong modifier, missing NPI — and generate denials on every single claim until you catch it.

Next: Telehealth Modifier →

Stage 1 — Practice Setup

Every CPT line on a telehealth claim needs a modifier.

Next: Fee Schedule →

Stage 1 — Practice Setup

Your fee schedule sets the ceiling — not the floor.

Set your billed rates for Dana's visit codes. Premera's contracted allowable is shown. Your fee must be at or above the allowable — otherwise your charge becomes the ceiling and you leave money on the table.

Setup complete — Verify eligibility →

Stage 2 — Eligibility

Dana calls to schedule. You run eligibility before the visit.

Your biller pulls benefits from Premera's portal. Here's what comes back:

Based on this, what do you tell Dana about her cost for today's visit?

A — "Your deductible is met — insurance will cover most of this visit. You'll just owe your $25 copay." B — "We'll verify with insurance and let you know what you owe after the visit processes." C — "Mental health is covered — there's no charge today." D — "We'll collect your $25 copay today. This is our best estimate based on your current benefits — the exact amount may adjust once the claim processes."

Dana arrives — now the visit →

Stage 3 — Visit & Coding

Dana's visit is complete. Time to code it.

Visit summary — Dana Reyes
CC: Follow-up, MDD and GAD. Telehealth.
Problems: MDD — partial response on sertraline 150mg. Discussed dose increase to 200mg after reviewing PHQ-9 (score 12, up from 9). GAD — anxiety elevated, reviewed recent stressors, continued buspirone. Both conditions actively managed with clinical decisions made.
Data: Reviewed PHQ-9 trend across last 3 visits. Reviewed medication interaction profile for sertraline dose change.
Risk: Prescription drug management with dose adjustment and active monitoring for side effects. Counseled on serotonin syndrome signs.
Psychotherapy (18 min): CBT targeting cognitive distortions around work performance. Patient identified automatic thought pattern and generated two alternative interpretations independently. Progress toward anxiety goals noted.
Total time: 36 minutes.

What is the correct claim for this visit?

A
99213 + 90833-95
Low MDM + add-on B
99214 + 90833-95
Moderate MDM + add-on C
99215 + 90833-95
High MDM + add-on D
99215 by time
36 min, no add-on

Submit the claim →

Stage 4 — Claim Submission

Review the claim before it goes out.

This is your last chance to catch errors. One missing element can deny the whole claim or just one line. Review each field.

Before submitting — is there anything that needs correction?

A — The claim looks correct. Submit as-is. B — 90833 doesn't need modifier 95 — it's an add-on, not a primary code. C — POS 10 is wrong — telehealth should use POS 02. D — The billed amounts are too high — they should match the contracted allowable.

Claim submitted — ERA arrives →

Stage 5 — ERA Review

The ERA comes back. Read it before you post anything.

An ERA is not a payment confirmation — it's a transaction record showing exactly how Premera processed each line. Read every column before touching your ledger.

What does the CO adjustment column represent?

A — Money the patient still owes after insurance pays B — The contractual write-off — the difference between your fee and the allowed amount, which you cannot collect from anyone C — A penalty for billing above the allowable D — An amount that can be billed to the patient if insurance doesn't pay enough

Post the payment →

Stage 6 — Reconciliation

Post the ERA to Dana's ledger.

Every dollar on the ERA must be accounted for. Insurance paid goes in. The contractual adjustment gets written off. Patient responsibility gets billed. The ledger must balance to $0 before the account is clean. Use the ERA above — enter each amount in the correct bucket.

ERA summary (reference): Total billed $215.00  |  Total allowed $168.00  |  Insurance paid $168.00  |  CO adjustment -$47.00  |  Patient responsibility $0.00

Check ledger →

Ledger balanced — now the patient →

Stage 7 — Patient Billing

The ledger is clean. Dana owes $0 — but you collected $25.

Insurance paid $168.00. Write-off posted $47.00. Patient responsibility: $0.00. You collected $25 at intake as an upfront estimate.

Dana calls: "I got a letter from Premera saying my visit was processed and I owe $0. But you collected $25 from me. What's going on?"

How do you respond?

A — "That $25 was your copay — you still owe it regardless of what insurance says." B — "You're right. We collected $25 as an upfront estimate. Since your ERA came back at $0 patient responsibility, we'll refund or credit that $25 to your next visit." C — "The $25 covered your visit cost. The ERA just shows what insurance paid — it's a different number." D — "Call your insurance company — they can explain the ERA to you."

Now run the same visit — different plan year →

Stage 7 — Patient Billing (Real-World Variant)

Same visit. New plan year. Different ERA.

January. Dana's deductible reset to $1,500. She has only met $400 so far. Same codes, same visit. Here is the ERA:

Insurance paid $0. Patient responsibility is $168. What do you do with the $25 you collected at intake?

A — Keep the $25 and send Dana a bill for the full $168 B — Apply the $25 toward the $168 balance and send Dana a statement for the remaining $143 C — Write off the $168 — it's not worth pursuing D — Appeal the ERA — insurance should have paid something

Generate the patient statement →

Stage 7 — Patient Statement

Ledger is posted. Generate the patient statement.

Your EHR billing module shows Dana's account. The ERA has been posted. The remaining balance is ready to bill.

Statement sent — see what happens →

Stage 7 — After the Statement

Statement sent. Now you wait.

Three days later, Dana calls.

"I got your statement. It says I owe $143. I thought my copay was $25. Did something go wrong?"

How do you respond?

A — "Yes — something went wrong. We'll fix it and reissue the statement." B — "The $25 was an estimate we collected upfront. It's January, so your deductible reset with the new plan year. Your full contracted rate applies until the deductible is met again. The $25 you paid was applied — you owe the remaining $143. We can set up a payment plan if that's easier." C — "Call Premera — this is their deductible, not our decision." D — "We'll just write off the $143 — it's not worth the hassle."

Dana agrees to pay →

Stage 7 — Payment Posted

Dana pays. The account closes.

What made this work: You set the expectation at eligibility ("this is an estimate"). You coded correctly. You submitted a clean claim. You posted the ERA accurately. You generated and sent the statement. When Dana called, you explained the deductible reset clearly and offered a payment plan. Every step connected to the next one.

Complete the cycle →

Cycle complete — Dana Reyes

You ran the full billing cycle.

Every dollar in your practice follows this path. Setup errors cascade into denials. Eligibility errors cascade into patient disputes. Coding errors cascade into revenue loss or recoupment. Reconciliation errors cascade into bad books. Patient communication errors cascade into collections problems. The cycle is one system — not seven separate tasks.

Practice in Billing Simulator → Return to Practice Lab

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Yes — billable psychotherapy Borderline — needs work No — not billable as documented

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