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Law Educator, Esq.
Law Educator, Esq., Attorney
Category: Personal Injury Law
Satisfied Customers: 111568
Experience:  Licensed Attorney. Over 20 years experience in personal injury and law enforcement.
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I need to narrow down the definition of a medical billing

Customer Question

I need to narrow down the definition of a medical billing code called "interactive complexity". I was seeing a psychiatrist for a while who was openly sharing my private information with an unauthorized individual for quite some time. This "individual" happens to be a trustee that controls the house I live in, he used a revoked power of attorney to speak with my doctor on numerous occasions but of course is denying it. I have one witness who will attest to the fact that they were speaking but the real proof I have is in this billing code that is used when there is a third party involvement. One month ago I made a records request and she promptly supplied some of the records. Another request was sent after that for specific information about a test that was conducted and she sent it with a note apologizing for having overlooked the results before. Another request was sent three weeks ago for specific information about why she charged my insurance company for interactive complexity and this request was completely ignored. After having sent two additional requests I finally paid them a visit yesterday and was told that she was sorting through the stack of papers and would definitely have what I needed today. This afternoon she called to report that there are no more records and that the billing code was used for administrative expenses but there were no notes about it on file. Medicare requires a doctor to keep detailed notes on why they billed for it and the criteria is very strict, it was certainly used for speaking with a third party and by definition can be anything else, at least that how I read it. but I'm stuck. I could subpoena the records but I know good and well that she will not provide them even if I do, I have every reason to believe that she has accepted money in exchange for my information but can't prove it. All I Have right now is a witness who they will most likely discredit and this billing code. Do you think the definition of interactive complexity is enough to merit a case? After reading the definition, consider the fact that I only saw this doctor for 5 minutes every three months for prescription refills and that's it... There were never any interpreters, guardians, or anyone of this nature whatsoever in any way shape or form.
Submitted: 1 year ago.
Category: Personal Injury Law
Expert:  Law Educator, Esq. replied 1 year ago.
Thank you for your question. I look forward to working with you to provide you the information you are seeking for educational purposes only.

Under the medical coding guides, "Interactive complexity, new add-on code 90785, refers to factors that complicate the delivery of a mental health procedure. Complicating factors include, for example, difficult communication with acrimonious family members and engagement of verbally undeveloped children. These factors are typically found with patients who:
  • Have others legally responsible for their care, such as minors or adults with guardians
  • Request others such as family members or interpreters to be involved during the visit, or
  • Require the involvement of third parties such as schools or probation officers

Code 90785 may be reported with codes for diagnostic evaluation, psychotherapy and group psychotherapy. At least one of several circumstances identified in the CPT manual that complicate the delivery of care must pertain in order for providers to bill the interactive complexity code as an add-on to the principal psychiatric procedure." See: http://www.apapracticecentral.org/reimbursement/billing/psychotherapy-codes.aspx

She cannot share your records with anyone without your specific written authorization or a court order. IF she is doing so this is a breach of the KS law on confidentiality of medical records and also a violation of HIPAA. For the HIPAA violation you must send a complaint to the US Department of Health and Human Services, as they are the only one who can investigate and sanction HIPAA violations and there is no private right to sue under HIPAA, you have to sue under state law.

Interactive complexity is not enough to prove that she violated your privacy rights. However, if she has shared information that alone is enough to pursue her for breach of duty of confidentiality and also the HIPAA violation.