Wiki non face to face assessment by psychiatrist to accept pt into psych services

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Is 99451 acceptable to use when a psychiatrist reviews an intake assessment that recommends psych services for medication management before accepting or declining the patient into psych services? I see in the guidelines that if review results in face to face services then do not code. If declined for services would this be appropriate to use? If appropriate to use, are there documentation guidelines stating what is required for this review?
 
So, let me see if I understand this. The psychiatrist reviews documentation and says, "nah, I'm not going to take this patient, but go ahead and bill his insurance for my time." Is that what you're saying? What is the scenario? Is someone presenting for mental health services and a psychologist or other therapist assesses them and says they have MDD or something similar and they are recommending med management? Then the psychiatrist reads the form and says, I disagree, give him a month and therapy and ask me again, or says, yeah, I'll take them?

Okay, let's break this down. A consult is when one provider requests the opinion and/or treatment advice of another provider, who has special expertise in that area (the consultant). The 99446-99451 codes are only used when the consultation does not result in a transfer of care or other face-to-face service within 14 days/next available appointment. Your scenario does not meet the definition of consultation, as the intake assessment is recommending the services, not asking the psychiatrist for his opinion and/or treatment advice.

If you were to change your intake forms to request the opinion of the psychiatrist, then the request would have to be documented in the patient's chart including the reason for the request, and the psychiatrist would have to put that opinion in writing for it to be a billable consult. And they have to have a billable/payable diagnosis. All for $30-$40.

So you have an assessment billed by one provider, then a consultation billed by another provider. Then if it's covered under the plan, and the patient sees an EOB with someone's name on it they don't recognize, they call the insurance company and say, I think this is fraud, I have no idea who this is. Then the insurance company says, the psychiatrist billed a consultation of your records. Then the patient says, I didn't give permission for that (even if they did). Then the insurance company requests the records. Then they see that the psychiatrist has basically checked off a box that says "not appropriate for med management". Yeah, I can see how that would go over well.

Am I way off base? Is there more?
 
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