Wiki 90791 prolonged services? Decisional Capacity exams

[kmbeam317@aol.com]

Hello all, is there such thing as a prolonged services code that can be used with 90791? Also, is 90791 the best code for a psychologist to use when doing a decisional capacity for a patient in either a skilled nursing facility, or assisted living facility? The therapists are using screenings such as MoCA, SLUMS, BIMS, but between administering the screenings and performing the rest of the necessary tasks, sometimes have visits that take longer than 90 minutes.

 

[CBLENNIE]

May I ask what you mean by "doing a decisional capacity for a patient"? Is this a form of competency exam/screening process? Does the patient have a diagnosed medical or mental health condition that makes this service medically necessary, or is this strictly an assessment of the patient's mental capacity?

Or are you trying to describe cognitive assessments, because if this is the case, I would think you would look at 99483:

• Assessment of and care planning for a patient with cognitive impairment, requiring an independent historian, in the office or other outpatient, home or domiciliary or rest home, with all of the following required elements: Cognition-focused evaluation including a pertinent history and examination, Medical decision making of moderate or high complexity, Functional assessment (eg, basic and instrumental activities of daily living), including decision-making capacity, Use of standardized instruments for staging of dementia (eg, functional assessment staging test [FAST], clinical dementia rating [CDR]), Medication reconciliation and review for high-risk medications, Evaluation for neuropsychiatric and behavioral symptoms, including depression, including use of standardized screening instrument(s), Evaluation of safety (eg, home), including motor vehicle operation, Identification of caregiver(s), caregiver knowledge, caregiver needs, social supports, and the willingness of caregiver to take on caregiving tasks, Development, updating or revision, or review of an Advance Care Plan, Creation of a written care plan, including initial plans to address any neuropsychiatric symptoms, neuro-cognitive symptoms, functional limitations, and referral to community resources as needed (eg, rehabilitation services, adult day programs, support groups) shared with the patient and/or caregiver with initial education and support. Typically, 60 minutes of total time is spent on the date of the encounter.

If 99483 describes the services being provided to the patient, you can actually bill for prolonged services with 99417 for commercial insurance plans or G2212 for Medicare and MA plans.

 

[kmbeam317@aol.com]

Thank you so much for your answer! The patients do have a diagnosed mental health condition, and are assessed by a psychologist to determine if they have decision making capacity by evaluating them for the ability to evidence a choice, ability to understand relevant information, ability to appreciate the situation and consequences, and ability to manipulate information rationally. Basically, do they have the ability to make their own medical decisions. The psychologists meet the documentation requirements for a 90791, and also usually perform one or more of the screenings I mentioned previously. I did look at the 99483 code, but did not think psychologists could use that code as it includes medication reconciliation, which does not fall under their purview. The 90791 on the other hand does not seem like the best choice, as the process can occasionally last longer than the proscribed max of 90 minutes for that code, and the clinicians want to be (and of course should be) compensated for their time.