Wiki 90801 billing

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monalisa

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I have a situation where 2 different providers in the same group have billed a 90801 for the same pt on the same day. I asked about this and he stated the doctor did a Medical intake and the Psychologist did a Psychosocial intake. This does not sound correct to me but I am new to billing for Psychiatrist and Psychologist in the same group. Any help would be great!

I was thinking maybe the doctor could have done it as a new pt visit? Or am I way off here?
 
Depending on if the patient has insurance. If No insurance then yes it is ok. If state insurance then only one can be billed the 90801, I'd chose the psychiatrist. Other insurance might be able to allow both but you would have to call that specific insurance. Why was it done on the same day? Was the client seen for an hour with both?
 
I am not sure but I did just get the denial. They state there is no way you can bill that code 2x on one day. Thanks
 
Then you need to bill a medical intake for the dr who did it and bill the initial eval for the dr who did that.
It is NOT ok to bill both evals just because a patient has or does not have insurance. You need to bill consistently across the board and you should not bill differently based on whether one has insurance or not.
 
I was thinking about the New pt e/m visit also and have spoken with the Dr regarding the documentation and he does have the documentation for a 99205. My question now is would it have to be a medical dx and go to the medical side of the insurance and not the carve out for Mental Health. Does the MH side of insurance except a reg E/M level visit from a Phsychiatrist with out a medical dx but a MH dx?
How does it usually work when you have an MD doing the medical aspect and the psychologist doing the Psych side of it. Can you bill a 90801 with two different providers on different days?
Thank you for any help I am new to billing for a group with an MD, and pyschiatrist and also LCSW all together. I have only done one or the other not a group where they have the pt being seen between providers in the group.
My thoughts also on med management and psycho therapy billing on the same day by different providers should have a modifier 59. Thoughts on this if any one has any would be helpful.
Is there any site where I can brush up on billing for a MH group?
 
monalisa said:
I was thinking about the New pt e/m visit also and have spoken with the Dr regarding the documentation and he does have the documentation for a 99205. My question now is would it have to be a medical dx and go to the medical side of the insurance and not the carve out for Mental Health. Does the MH side of insurance except a reg E/M level visit from a Phsychiatrist with out a medical dx but a MH dx?
How does it usually work when you have an MD doing the medical aspect and the psychologist doing the Psych side of it. Can you bill a 90801 with two different providers on different days?
Thank you for any help I am new to billing for a group with an MD, and pyschiatrist and also LCSW all together. I have only done one or the other not a group where they have the pt being seen between providers in the group.
My thoughts also on med management and psycho therapy billing on the same day by different providers should have a modifier 59. Thoughts on this if any one has any would be helpful.
Is there any site where I can brush up on billing for a MH group?
Click to expand...

You can bill the EM with a psych dx if that's what the dx is/was. Some insurances you may have to fight with a bit, but you can usually get it to go. We used to bill more em's but not much anymore. 2 different providers in the same group CAN bill a 90801 IF they are different kinds of providers (ie SW and psychologist)
I am not sure if you need a 59 because 2 different dr's are seeing pt.. i guess since there is a cci edit on it, you would be ok with it and probably avoid alot of back end work I like this site, but we are with WPS:

http://www.wpsmedicare.com/part_b/policy/policy_active.shtml
 
if we bill a medical would it go to the medical side and not the mh side of the ins?
This is state Medicaid plan.
Thanks
 
Billing for 90801 for the same patient

I have a situation where two physicians are in the same group practice. The patient has been established with Physician #1 for a number of years, but Physician #1 is now transferring the patient to Physician #2 who will be treating the patient for the same condition. Physician #1 billed 90801 at this patient's first encounter. Now that Physician #2 is taking over care, Physician #2 wants to bill 90801 because she wanted to re-evaluate the patient herself to be sure the patient was diagnosed correctly.
Would it be appropriate for Physician #2 to bill 90801?
TIA!
 
Perhaps it would be correct. I think you should look at the amount of time that has lapsed since the patient had the initial evaluation.

Also, consider if the patient has new conditions or circumstances that have substantially changed since the initial eval.

While Medicare has time limits on the 90801, I am not sure of the private carriers. I cannot imagine that they would be all that different.

I hope this helps some.
 
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