ONESTEP SCRIBE

Clinical documentation guides

Practical guides for psychiatric prescribers by Selam Koch, PMHNP-BC, founder of OneStep Scribe and practicing psychiatric nurse practitioner.

CPT 90833 note example: an audit-ready E/M plus psychotherapy add-on note, annotated

A complete fictional example note with annotations showing exactly what a payer reviewer checks in each section.

Billing 99214 and 90833 together: the documentation that survives review

The billing rules behind psychiatry's most common code combination: MDM-based E/M selection, the 16-minute rule, and the denial patterns to avoid.

Billing CPT 96127 for scored behavioral screens

What CPT 96127 covers, how it pairs with an E/M, how it differs from the testing codes, and the documentation that supports the claim.

Psychiatric SOAP note example: what each letter carries, annotated

The S/O/A/P discipline for mental health, a complete stimulant follow-up example with vitals and monitoring, and the five most common structural errors.

PHQ-9 and GAD-7 in clinical notes: scoring, interpretation, and documentation

The severity bands, the trajectory conventions, what a positive item 9 requires, and note snippets that make scales worth the thirty seconds.

Measurement-based care in psychiatry: documenting scores that count

Which scales to use at intake versus follow-up, a workable cadence, and how to document the score, its interpretation, and the decision it drove.

Beyond PHQ-9 and GAD-7: choosing the right psychiatric rating scales

Which rating scale fits each clinical target beyond the PHQ-9 and GAD-7, with self-report versus clinician-rated, licensing, and cadence guidance.

Psychiatric progress note example: an annotated medication management follow-up note

The four things every follow-up note has to prove, a complete annotated example, and the five ways progress notes quietly decay.

90791 vs 90792: which to bill, with a complete psychiatric evaluation note example

The medical-services distinction, the same-day rules, and a full annotated evaluation note that works for prescribers and therapists alike.

The mental status exam: how to assess and document every component

Mood versus affect, the descriptor vocabulary that works, two complete documented examples, and the five ways MSEs go wrong.

Mental status exam vocabulary: the precise term for every MSE component

The accepted descriptors for every MSE domain with plain-language definitions, so the exam says what you actually observed.

Psychiatric intake questions: building a defensible evaluation, domain by domain

The questions that actually elicit useful data across HPI, history, substances, family, and risk, and what to capture in the note.

Documenting an adult ADHD evaluation: criteria, scales, and a note that supports the diagnosis

The DSM-5-TR criteria mapped to your note, childhood-onset evidence, rating scales, and the documentation stimulant prescribing requires.

Bipolar vs borderline: the differential, and documenting your reasoning

The classic differentiators, why they co-occur, and an example assessment paragraph that shows the work instead of just the label.

Suicide risk assessment: what a defensible note contains

The complete component list, safety planning over contracts, and two documented examples where the plan matches the stated risk level.

Choosing an AI scribe as a psychiatric prescriber: an honest comparison

Why prescriber notes are structurally different, what to demand from any AI scribe, and how the current options position themselves.

Choosing an AI scribe as a therapist: an honest comparison

The audit realities of therapy notes, a vendor-agnostic checklist, and a sourced look at the current options for LPCs, LCSWs, LMFTs, and psychologists.