Wiki Coding/billing for new pt psyh eval and MAT service

[reddaway@sbcglobal.net]

Is there a resource for me to check if a new patient can be seen by the same psychiatrist on separate visits and be billed separately for a new patient psych eval and the other visit for new patient med review for approval of MAT service in the same facility or if those 2 services can be combined at same visit and use modifier 25 appended to MAT E/M code? Is it double dipping to see same new patient on separate dates for separate services - one for initial psych eval for MH issues and the other for medication review for approval to begin MAT services.

First time this has come up in my OP MH facility so we need to make sure were are correctly providing the service and coding and billing correctly.

 

[TThivierge]

Hi
I use to work in behavioral health clinic years ago thus can offer some help. Checking on patient past medical services in same year could be done by filing claim then it will get rejected if pt. trying to be treated by 2 mental health doctors for same dx problem/issue. You can checking online with payer but probably will not reveal that before service done due to privacy issues. Ask the patient if being seen somewhere else; they may lie though. Patients are allowed to see family doc for chronic health problems, a psychiatrist MD for psych problems which may result in injections/med management and a differ licensed therapist for another behavioral issue . You would use modifier 25 on office E/M code90805 if doc on same day did differ CPT problems such as office visit and then a smoking cessation 99406 or med management 90862 same day and time. Ensure provider document each thing done on same day. Also if does smoking cessation if pt. a nicotine smoker, list note as " discussed with patient 10 minutes cease smoking options; get the nicotine gum, get a patch, start a hobby, more exercise, Etc." Point is the minutes must be in written notes for the day of stop smoking cessation.
Also pre cert the approvals on ongoing therapy, mail claims where ins card states which is usual different than the medical health claims. Also use same dx code each time on claims which is done on preautho request . Keep psychiatrist and therapists credentialing CAQH up to date or it will deny. Here is more added info.... noticed in the ICD10 manual the dx block of R45 can add if this is in the therapist's documentation of adjectives incurrent HPI. Understand differ in remission vs use vs dependence in drug abuse and use F17 instead of Z72 on a claim if clinician discuss current smoking habit. Medicaid & Medicare in your state may want certain modifiers to define type of clinician.

I hope this info helps you
Lady T