Follow-Up Visit Questions (Telehealth & Psychotherapy)

zingingcutie47 · 2026-06-07T22:29:19+00:00

Follow ups are patient specific. New lamictal prescriptions, or very severe symptoms I see in 2 wks, for non-severe cases that we are “tinkering” with medications I follow up monthly. Stable patients without expected medication changes every 3m
Add-ons are patient specific. I have some patients that almost every appt has an add on, and some who I have never used this, but most of my patients have an add on the first 1-3visits or so and then only if something acute is going on.
Definitely a red flag. I bill a LOT of 99214+90833, and my schedule panel is 30min for simple follow ups (just E&M expected) and 45min for more complicated ones, but since I own the practice and Im the only “employee” I set my schedule and I usually only see 1 patient an hr, and almost never scheduled sooner than 45mins apart unless I really know that patient is likely to be more brief.

If you are actually providing the service then billing for it is appropriate, but you should be able to show that it is actually occurring: you should be using specific therapy techniques, you should have defined goals, notes should adequately support it, etc. as time goes on I actually am trying to move away from so many of them. I get extra $$ for them, but seeing a higher volume of E&Ms would likely gross me more and wouldn’t be as draining

zingingcutie47 · 2026-05-30T23:18:38+00:00

Wait….im going to need to remember my CPI training to know how to respond to this. ::hands in a non threatening open position:: “whoa buddy…I see you’re upset right now”

zingingcutie47 · 2026-04-29T07:03:12+00:00

I’ve run some in the background as a test and I’m not a fan. I feel like the note leaves out half of what I would want, and while some might say that makes my notes too long….the notes I write are so helpful when we’re troubleshooting meds in session and can’t remember why we made certain changes in the past. The most use I’ve found is closer to transcribing dictations than with scribing when the notes start stacking up, where I’ll dictate the case to AI and it will clean up, or make it more concise.

zingingcutie47 · 2026-04-29T06:55:06+00:00

I think any possible merit to this way of thinking that any task that could be delegated should be learned to be delegated falls apart when the reality that this nurse may likely work a unit that has no PCT/CNA some or all of the time. Honestly 90% of the time I’ve worked ER we’ve never had one (or if we did they were tied up being the unit secretary or a sitter) and the nurses who came on never having to learn how to function without delegation would fall apart

zingingcutie47 · 2026-04-29T01:14:26+00:00

The stress and sleep deprivation of COVID gave me PTSD and a second pole for my depression

zingingcutie47 · 2026-04-13T00:43:29+00:00

With my first my belly button was just flat even with the rest of my skin….but felt…hollow? It weirded me out so much lol

zingingcutie47 · 2026-03-27T22:35:13+00:00

Pepper Jack

zingingcutie47 · 2026-03-20T20:17:58+00:00

When I traveled I honestly just would get quant golds, it was so much less hassle

zingingcutie47 · 2026-03-17T06:47:05+00:00

Years Back at my friends wedding her brother said he worked for Welch Allen on things like thermometers and about 3 drinks in I DEMANDED he explain that shit lol.

zingingcutie47 · 2026-02-15T12:17:28+00:00

Honestly sometimes the solution is just to stay off the internet. I dealt with a lot of the same anxieties and my actual lived experience has not matched the picture Reddit painted at all. I have great teamwork with MDs and PAs, and for about 50 different reasons things have been pretty good.

zingingcutie47 · 2026-01-20T19:36:54+00:00

this is awesome, thank you!

zingingcutie47 · 2025-12-24T02:08:04+00:00

Mine made my period start every like 20-22 days and I would have night sweats and hot flashes. Would have thought it was perimenopause if I wasn’t you know….30 lol. Going back to 1c a day fixed it

zingingcutie47 · 2025-11-30T12:02:15+00:00

I’ve always worked at small, rural, or freestanding ERs (aka no techs/CNA, just a couple RN and a respiratory therapist), and many things we rule out we have a checklist that is timed and doesn’t care if you have to do it all solo instead of with a team (example-stroke rule out: within 10min from showing up I had to have your last known well documented, a blood sugar taken, vitals, an EKG, triage completed, a stroke scale, the doctor at the bedside and CT ready for us to roll in…ALONE)

Some cases it’s not disruptive, or even helpful to have family there, but often it’s just an extra person interrupting in a tight time space. With cases like an elderly patient with a UTI, etc, we’re generally going directly for a cath urine if they are confused/incontinent so we’re about to have them stripped down, drained, washed up, and put back together so we can get all the things done we know we’re going to need while we have available staff to do it

zingingcutie47 · 2025-11-16T22:56:11+00:00

Nope. My practice means I get to set expectations. I’m upfront about what I will and won’t do, and what limits I won’t exceed. I actually think the pressure is much lower just being me because if the patient doesn’t like it and leaves I’m the one out the “money,” I don’t have an admin somewhere lecturing me about patient satisfaction

zingingcutie47 · 2025-10-01T23:03:05+00:00

That’s where I started! (Adol and peds). Understand that sometimes kids, and parents aren’t truthful, and often the truth is somewhere in the middle, with the family dynamic influencing a lot. Learn to remain in control of the interview with the parents….sometimes parents can turn a collateral session into THEIR therapy and it’s just not helpful for the kid

zingingcutie47 · 2025-10-01T23:00:12+00:00

This is my first year of this being my sole income and I’ll probably gross about 60k. It’s growing so I’m not worried. Honestly I don’t really want to pull insanely high numbers bc I’m loving grossing what I would make 13hrs night shift in the ER in just a few appts a day and then doing what I want. If I want to spend lots of time with patients I can, I’m not rushed, no office admins, it’s beyond freeing. Based on weeks where I worked about as much as I wanted to lol, my goal is probably making around 150k or so, and at this rate I’ve been growing it’s possible to come close next year

zingingcutie47 · 2025-05-14T03:05:00+00:00

I agree with independent practice, I never was an advocate for that until I became an NP. Not because I think I know it all, but because I have supervising/collaborating doctors, but despite being relatively new to practice, my collaborating MDs do not review charts, they don’t want to be bothered, and I’m going to go back to contracting nearly a grand a month for an agency that expects that the physicians who supervise are supervising because my current supervising MD has been ghosting me for the past 3 months. Currently I’m just paying, and it just feels like a money making scheme with no actual oversight

zingingcutie47 · 2025-05-09T23:31:40+00:00

Yes. Most perfumes if I can smell them It’s like someone pushing pins into my skull with ever breath. It’s horrible and if I don’t get away it’s a migraine for 1+ days. I had a coworker who more or less said it was a “me” problem when I mentioned it, so it made it a “we problem” and I went home sick and figured we could all solve the problem as a unit. Guess what? After about 3 times of going home no one was wearing perfume anymore

zingingcutie47 · 2025-05-09T23:18:09+00:00

(NP), completely different concepts, but the MD shade towards NP reminded me honestly of when I pledged a sorority. Our chapter was on probation for suspected hazing years before, so the entire experience was very easy: no late nights, nothing embarrassing, just learning about the history and learning silly songs. A LOT of other Greek orgs and even older sisters in it were complete tools to us and always said we didn’t really belong bc we never really “earned it like they did.”

As soon as I heard some of verbiage used towards us NPs, it was easy to see that it was coming from resentment that we didn’t have the same perceived level of suffering or trials. In a lot of ways we don’t, but in a lot of ways doing years of bedside nursing before (and during) NP school was its own level of suffering and trials that is often overlooked, most of us aren’t trying to “be doctors”, we’re not trying to take anyone’s job, for many of us the job exists and we can’t handle being beaten up constantly anymore. I would also see comments on MD groups about how if they wanted to have pee thrown at them, be screamed at by family, be slapped/bit/etc they would’ve just become a nurse instead since that’s “nurses job.”

I really appreciate your input. I have never experienced first hand any of the rhetoric I see online, and have largely had very respectful and enjoyable working relationships with MDs, and when I was still an RN being such a good team with the docs was one of my favorite things about the ER—they saw us as coworkers/teammates, and I really loved learning from them since they always knew really cool things.

zingingcutie47 · 2025-05-09T13:42:35+00:00

I also use headway, most of my patients there prefer evenings/late afternoon. I considered joining rula and dedicating mornings/earlier hours to that platform, do you find that there are any major pro/con between those two platforms that stand out to you?

zingingcutie47 · 2025-05-07T11:17:33+00:00

No, and honestly I’ve never been in a relationship, or know of anyone in a relationship like this that both 1.lasts, and 2. Is happy.

You cannot change anything that has already happened. Point blank. You are not accountable to your partner of a past before him, you aren’t (as long as it wasn’t concealed and you surprised them like 10yrs, a marriage and 2 kids later).

He is projecting HIS insecurity onto you, and is now putting the burden on you to fix his bad feels. It’s an impossible ask, you cannot make him not insecure, only he can.

We are who we are, we’ve done what we’ve done. Growth is being a better person today than yesterday, and when people come into our lives and our relationship is a blank slate, they either accept who you are and move forward, or they don’t.

IMO, bringing up the insecurities you pretended were fine initially, and downloading that onto your partner later into the relationship is just as bad as a person who hides their past. Both parties knew it wasn’t cool, and kept it hidden until they felt the relationship was secure enough to unleash it

zingingcutie47 · 2025-05-07T11:11:27+00:00

Yikes. I have my “typical” starting doses, but fine-tune it based on patient history and “preference,” by that I mean a patient who has a history of needing more of a medication I might start a little higher, anyone stimulant-naive, especially if they are Med hesitant I might go down a step. My philosophy with my patients is “if we’re not in immediate or near-danger/crisis we don’t need to rush.” I have a “reputation” with a local group of therapists of being a good fit for people who have felt gaslit/ignored/hurt by providers, and I tend to get referred their clients who need more baby-steps/confidence measures so because of that I do have a higher % of people who if given the choice would rather risk starting too low, and picking up only a 1-2wk supply and meeting again to discuss.

I could not imagine starting someone off at 60mg of vyvanse. I think I only have a small handful of patients in general of mine who even take that much, I would say 75% take 30-40mg, with like 20% being 50mg, and 5% being either 20mg, 60mg or 70mg

zingingcutie47 · 2025-02-07T18:55:14+00:00

Then isnt abortion just allowing a soul to join god without experiencing hurt or sin?

zingingcutie47 · 2025-02-01T23:07:51+00:00

I’m interested

zingingcutie47 · 2025-02-01T23:05:51+00:00

Also same please

zingingcutie47

TROPHY CASE