Coding for Social Security Disability Psychiatric Evaluations

jwishart

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How do you code for Social Security Disability Psychiatric Evaluation Exams (without a full medical exam) performed by a Psychiatrist?

I dug and dug but couldn't find info on this anywhere and Social Security didn't know either.

I was thinking we would use both 90791 + 99456 if the Dr. was not going to be treating the patient.

The 99456 would cover that it is a disability exam and the 90791 would cover that it is a psych eval but no treatment.

Does this sound correct? Also, who pays for these besides attorneys... Medicare or is it HHS for each state? Thanks!
 

SharonCollachi

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My former boss did these all the time. If social security sent the patient to you, you bill social security. These are not billed to regular insurance. They should have sent you an authorization form listing what they want to be done, with some things that are optional. We billed non-cpt codes with the agreed-upon rate. For instance:

Exam - EXAM $500
Testing/MMPI - MMPI $325
Testing/Beck Depression Inventory - BECK $250

Optional tests would be things like tests of malingering (TOMM).
 

jwishart

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My former boss did these all the time. If social security sent the patient to you, you bill social security. These are not billed to regular insurance. They should have sent you an authorization form listing what they want to be done, with some things that are optional. We billed non-cpt codes with the agreed-upon rate. For instance:

Exam - EXAM $500
Testing/MMPI - MMPI $325
Testing/Beck Depression Inventory - BECK $250

Optional tests would be things like tests of malingering (TOMM).
Do you have examples (without PHI, of course)? My email is: jwishart@heartlandfamilyservice.org. Thanks! :)
 
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