Wiki Can I bill a 90801 again??

Create Wiki
1

1073358

Expert
Messages
454
Location
Merrill, WI
Best answers
0
Dr originally sees pt for work problems. Then she goes 3 months without seeing the patient. Patient returns with new complaints of marital problems. Can I bill a 90801 again since its a new issue with a new treatment plan?
The rule I have on 90801 says this code may be billed once, per provider/discipline, at the onset of an illness or suspected illness. It may be utilized again for the same pt if a new episode of illness occurs after a hiatus, or an admission/readmission, to an inpt status due to complications of the underlying condition.

What exactly do you think if a new episode of illness occurs after a hiatus means? Clarification would be great on this.
 
Psychiatric Diagnostic Interview Examinations (90801, 90802)

A diagnostic interview may be indicated for an initial or periodic diagnostic evaluation of a patient for suspected of diagnosed psychiatric illness. This service may be covered once, at the onset of illness or suspected illness. However, additional diagnostic interviews may be covered if a new episode of illness occurs after a hiatus, a new inpatient admission or re-admission occurs, or if the evaluation is required in order to address a new question.

A hiatus is like a break/interruption...
 
My Take on this....

1073358 said:
dr originally sees pt for work problems. Then she goes 3 months without seeing the patient. Patient returns with new complaints of marital problems. Can i bill a 90801 again since its a new issue with a new treatment plan?
The rule i have on 90801 says this code may be billed once, per provider/discipline, at the onset of an illness or suspected illness. It may be utilized again for the same pt if a new episode of illness occurs after a hiatus, or an admission/readmission, to an inpt status due to complications of the underlying condition.

What exactly do you think if a new episode of illness occurs after a hiatus means? Clarification would be great on this.
Click to expand...

per the e&m section, where 90801 and 90806 falls, only the eval code can be billed once per provider every 3 years. They can go to a different doc to get an 90801 availaible, otherwise the doctor/therapist can only get the established psych therapy codes. Actually, i believe there is a code specific to marraige therapy... Check that out. Hope this helps!!! Pjm
 
paulmuir said:
per the e&m section, where 90801 and 90806 falls, only the eval code can be billed once per provider every 3 years. They can go to a different doc to get an 90801 availaible, otherwise the doctor/therapist can only get the established psych therapy codes. Actually, i believe there is a code specific to marraige therapy... Check that out. Hope this helps!!! Pjm
Click to expand...

I think that the 3 year rule you are referring to is for the EM office visit codes. Psych codes are in medicine section and no where in there does it say 3 years to my knowledge...??
 
I was thinking the same thing about the 3 yr rule and was unable to find that info in the CPT book. Maybe it's a rule specific to that users state? We see primarily inpatients and may bill multiple 90801s for 1 patient within a 3 year period because they may have several admissions within that time.

Pjm - I may be missing something. Please direct us to where this info is located. I checked the Psychiatry guidelines in the CPT book and was unable to find the 3 yr rule. Thank you.

For marriage counseling you may be able to use 90847 for conjoint therapy (patient and spouse present).
 
I'm away from my resources for travel, but the 3 year applies to 90801 and 90802. This information is a CMS standard, if I'm not mistaken.

Keep in mind that a full psych is a full-fledged evaluation, not a code or service of exclusion.
 
Is someone has documentation from Medicare on the 3 year rule, please post it for me so I can use as a referrence.
 
Hi,
I had a situation with Aetna where they denied our request for authorization for testing by a PhD because the 90801 evaluation (by an MD in our pratice) was 6 months old. After the PhD completed a new evaluation we were granted the authorization for testing.

I promise this is True!
 
I am having a similar problem. Therapist saw client at a one site, saw her for therapy then after 3 months decidided to see her at other site but needed a 90801 to open her to the new site. i checked with her insurancea and yes if they stop coming for 6 months you can do another 90801. my problem however is she was being seen for the full 3 months then he did an intake form to open her to the new site but wants to bill it as a 90806 since we wont get paid for another 90801. does anyone know the rules about this? i say no you cant bill a 90806 when the documentation clearly shows a 90801.
help please they wont believe me :(
 
lizalambert said:
I am having a similar problem. Therapist saw client at a one site, saw her for therapy then after 3 months decidided to see her at other site but needed a 90801 to open her to the new site. i checked with her insurancea and yes if they stop coming for 6 months you can do another 90801. my problem however is she was being seen for the full 3 months then he did an intake form to open her to the new site but wants to bill it as a 90806 since we wont get paid for another 90801. does anyone know the rules about this? i say no you cant bill a 90806 when the documentation clearly shows a 90801.
help please they wont believe me :(
Click to expand...

"needed a 90801 to open her to the new site"
If he has already been consistently treating this patient, why would he need to do another 90801? Couldn't ha just have had copies of her records sent over to the new location? I guess I would question the necessity of another visit..
 
You are correct. You can only bill for what you actually document not for reimbursement purposes. If you would like to find something in writing you may want to check the coding guidelines in your CPT book, Medicare NCD or LCD, and/or with your local payer.

Coding and billing for something they didn't do will get them into trouble.
 
A little late in finding this forum, but I work for a state agency that services consumers with mental health, substance abuse and developmental disabilities and the contracts that we as a state agency and Community Service Board allows the code 90801 to be provided once every 6 months and in the case of an urgent need such as a consumer that stopped services and completed decompensated then a preauth is required. Medicaid allows for the 90801 yet monitors as the same with Medicare. We utilize LCSWs and since Medicare only pays for an MD, CNS, PhD, LCSWs our LCSWs will provide the initial assessment to determine the level of service and if the consumer meets core criteria and then an appointment is made to see a physician who will then also bill 90801 and since the NPI designates the licensure we have experienced any problems with Medicare. Medicaid uses alot of H codes so a clinician can always bill H0031 or H0032 and then the physician can bill 90801.

Hope this helps...
Wendy, CPC
 
Paper work involved in doing the 90801

Can we include the time doing paper work for the 90801 procedure code? A lot of times it would take our clinicians to do 90801 for 1 hour and another 1/2 hour to finish the paper work. Should we code it with 90801-22? Please help.

thanks,
Raquel
 
rnakahara said:
Can we include the time doing paper work for the 90801 procedure code? A lot of times it would take our clinicians to do 90801 for 1 hour and another 1/2 hour to finish the paper work. Should we code it with 90801-22? Please help.

thanks,
Raquel
Click to expand...

90801 does not have a time value assigned to it per CPT, so no, you should not bill a 90801-22.
 
rnakahara said:
Can we include the time doing paper work for the 90801 procedure code? A lot of times it would take our clinicians to do 90801 for 1 hour and another 1/2 hour to finish the paper work. Should we code it with 90801-22? Please help.

thanks,
Raquel
Click to expand...

Funny I was just re-reading about this today in the CPT Handbook for Psychiatrists. It states that a 90801 is not a timed code, but the initial eval generally takes 45 minutes to an hour. In instances where the eval would take longer than that, the CPT, modifier -22 should be used. Be sure to document the extra time and explain why it was required.

BUT I guess this wouldn't work in your case because it's relating the extra time to the actual eval not paperwork.

Hope this helped.
 
You must log in or register to reply here.
Top