Psychiatry Coding & Reimbursement Alert

Published on Tue Sep 04, 2012 PDF

Question: A physician in our outpatient department performs behavioral therapy for obesity for Medicare patients. Recently, one of the psychiatrists came up and told me that since this service involves behavioral therapy, these patients should actually be referred to him and not be seen by the physician. I am of the opinion that psychiatrists are not among the listed professionals who can provide this service to Medicare patients but he fails to take my point. Can you clarify on who is right and point out some documentation that I can show him to give credibility to my stand?

Dallas Subscriber

Answer: You are right in your stand that psychiatrists cannot provide intensive behavioral therapy for obesity to Medicare patients. As per Section 200.3 of Chapter 18 of the Medicare Claims Processing Manual:

For claims with dates of service on and after November 29, 2011, CMS will allow coverage for face-to-face behavioral counseling for obesity, 15 minutes, G0447, along with 1 of the ICD-9 codes for BMI 30.0-BMI 70 (V85.30-V85.39 and V85.41-V85.45), only when services are submitted by the following provider specialties found on the provider's enrollment record:

• 01 - General Practice
• 08 - Family Practice
• 11 - Internal Medicine
• 16 - Obstetrics/Gynecology
• 37 - Pediatric Medicine
• 38 - Geriatric Medicine
• 50 - Nurse Practitioner
• 89 - Certified Clinical Nurse Specialist
• 97 - Physician Assistant

Any claims that are not submitted from one of the provider specialty types noted above will be denied.

For claims with dates of service on or after November 29, 2011, CMS will allow coverage for Face-to-Face Behavioral Counseling for Obesity, 15 minutes, G0447, along with 1 of the ICD-9 codes for BMI 30.0-BMI 70 (V85.30-V85.39 and V85.41-V85.45), only when submitted with one of the following place of service (POS) codes:

• 11 -- Physician's Office
• 22 -- Outpatient Hospital
• 49 -- Independent Clinic
• 71 -- State or Local Public Health Clinic

Since your psychiatrist is not among the specialties listed above, Medicare will deny the claim for these services if provided by him. So it is best that your other physician (assuming he or she is among the covered specialties listed above) who is performing these services in the outpatient department of your facility continues the services that you will report with G0447 (Face-to-face behavioral counseling for obesity, 15 minutes) or else you will face denials if these Medicare patients are referred to your psychiatrist.

You can find documentation of these requirements by visiting the CMS website at http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c18.pdf.