Wiki Certification on capacity

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A new patient came in yesterday for a brief evaluation to have a Certification on Capacity completed. Patient has Medicaid/Medicare. I have no vitals, just a photocopy of the certification on Capacity form completed at the time of this one and only visit for the patient. How would you code this? We are an FQHC, Article 28 clinic.

There is a breif statement indicating age of patient, physician, last IQ, and need for dialysis and fistula procedure due to DM. Physician then rendered his opinion on whether or not the patient comprehended the procedure. I have no vitals, no separate note that indicates a physical examination, just a copy of this CQCAPD form 210 in chart, and no ABN.

Thoughts?
 
Certification on Capacity

I am still looking for feedback on this question. Would anyone recommend the unlisted psychiatric procedure code?
 
I am thinking you could look at 90885-90889? I am not really sure. I dont know what this CQCAPD form is. Does it contain enough info to bill a 90801?
 
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