Don't mean to hijack this thread, but I was thinking this:

Diagnoses and billing and coding are very complicated using the DSM-5, ICD-10, and CPT codes for behavioral health services. I think there's a CPT code for just medication management, but if the appointment morphs into "counseling," even unintentionally, the pdoc can tack on an additional charge for reimbursement. Knowing this makes me want to take a stopwatch into an appointment and hit the door at 14-1/2 minutes and then check his billing to see what was submitted to insurance. My pdoc enters notes on his PC during the appointment, so he prints out and hands me a med sheet and closes the file as he accompanies me to the appointment desk. This means he can immediately bring in another patient. "Next!" Pretty efficient.

I don't distrust my pdoc, but I've seen more than once that a couple of codes (or even three) were billed when the appointment seemed almost mechanically brief. "How're you doing?" "Okay." "So we don't need to tweak meds, then." "Nah. Don't think so." I should just walk out then. But instead, he asks, "How is work going?" "Pretty stressful." "Well, I recommended that you not work, remember?" Then the total visit goes, say, 18 minutes. I like him a lot, and I think he enjoys my visits (or acts like it, anyway), so talking over the 15-minute allotted time is not unusual.

I think med management visits are just a bunch of **** really. Patients, I think, feel short-changed, but doctors do, too. They usually don't want to function as pill pushers, and they mostly go into psychiatry because they want to help PEOPLE (and they can have good work/life balance in this field). Having an alliance with a patient doesn't occur in four 15-minute appointment throughout the year.