evaluation for memory difficulties examination 2-3 hours

SSweetland

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A patient is seen in the office for a series of tests done by a trained LPN for tinnetti assessment tool (gait), geriatric depression scale, Nutritional Risk assessment, hearing handicap Inventory screening, which can take up to and hour or more. The forms are scored and the physician does a comprehensive examination, interpretation of all the tests and discussion with patient and family. The total time can be 2-3 hours total. I am looking at several Psychological testing CPT codes in the 96101-96127 CPT codes but I am not sure if the screenings meet any of these codes except for 96217 Depression inventory. I am wondering if the provider could use these codes or resort to an E/M code based on time for counseling which would lead into extended time CPT codes. Any information would be greatly appreciated.
Sheila
 

SSweetland

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most of these visits are Medicare patients. I am wondering if Mini Mental exam are not enough and only the E/M code is going to be allowed. Maybe with extended time because of the time factor. Any information or places I can get information in regards to this matter would help. Thanks for responding
 
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Are you entering codes for any services that could qualify for preventive services for MC? Also, have you looked at the codes for prolonged services? Without knowing all of the specifics of the visit it's really hard to point you in the right direction.
 

SSweetland

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thank you so much for your input. Right now the physician was charging a 99215 with >50 % counseling the patient and family. After reviewing this I am checking to see other ways of billing these 2-3 hour examinatins. his staff performs mini mental tests that are related to Tinnetti assessment tool- series of 9 different balance tests and scored, Geriatric Depression Scale - 15 questions , Nutritional risk assessment 10 questions, Hearing Handicap inventory for the Elderly HHIE-S and that also has 10 questions. The provider then reviews, examines the patient and has a meeting with the patient and the family. total time is 2-3 hours. I was performing an internal audit on 99215 an came across this service which prompt me to see if he should be utilizing different codes with either psychology codes or extended time. I found under 96102 cpt code on the AAPC electronic coder it states For mini-mental examinations performed by a physician, see Evaluation and Management service codes. this is what leads me to E/M with extended time codes in the office setting and utilizing his staff. Do you Agree?
 
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I'm not familiar with these codes at all, but maybe it's worth a look? I know there are a LOT of parenthetical notes but I found several places that used these three codes together: 99213, +90836, +90875

When I pull 90785 up online it says:
"90785 Interactive complexity (List separately in addition to the code for primary procedure)

Notes:
(Use 90785 in conjunction with codes for diagnostic psychiatric evaluation [90791, 90792], psychotherapy [90832, 90834, 90837], psychotherapy when performed with an evaluation and management service [90833, 90836, 90838, 99201-99255, 99304-99337, 99341-99350], and group psychotherapy [90853])

(Do not report 90785 in conjunction with 90839, 90840, or in conjunction with E/M services when no psychotherapy service is also reported)

(Do not report 90785 in conjunction with 90839, 90840, 0364T, 0365T, 0366T, 0367T, 0373T, 0374T)

This add–on code represents communication factors that add to the difficulty of service delivery and increase the intensity of effort required of the provider in a particular treatment session. There are various factors that make the psychotherapy session more intensive in effort like high reactivity or disagreement among family members, emotions or behavior of the caregiver that hinder execution of the treatment plan, situations involving abuse or neglect that the provider must legally report, use of play equipment or other objects to assist communication, or the need for an interpreter or translator because of the patient’s lack of fluency or undeveloped verbal skills. [It mentions elsewhere that difficulty in communication is acceptable as long as that difficulty is specified and an explanation of how it affected the visit are included in the provider's note]

This code can be reported with code(s): 90791, 90792, 90832, 90834, 90837, 90833, 90836, 90838, 90853"

Here's what I found for 90836:
"90836 Psychotherapy, 45 minutes with patient and/or family member when performed with an evaluation and management service (List separately in addition to the code for primary procedure)

Notes:
(Use 90836 in conjunction with 99201-99255, 99304-99337, 99341-99350)

In this add on service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient in addition to an evaluation and management service in the same session. The treatment session typically lasts for anywhere between 38 to 52 minutes and may or may not involve the patient’s family members.

Psychotherapy is a type of therapy in which the provider uses a series of techniques to treat the mental and emotional health problems of a patient. Psychotherapy includes the interactive process between the provider and the patient. The provider involves the patient in this therapeutic interaction with the aim to explore the thoughts, feelings, and behavior of the patient. The provider uses a variety of techniques based on relationship building, communication, and behavior change that target improvement of the mental health of the patient. For this code, the provider should spend approximately 45 minutes but no less than a minimum of 38 minutes and a maximum of 52 minutes face to face with the patient and or a family member in addition to the evaluation and management service performed in the same session.

Bill this code separately in addition to the code for the primary evaluation and management service.

Tips
Use code 90834 when the provider performs a psychotherapy session for 38 to 52 minutes without an additional evaluation and management service in the same session.

Because +90836 is an add–on code, payers will not reimburse you if you report it without an appropriate evaluation and management service code, specifically 99201–99255, 99304–99337, 99341–99350."

:confused:
 
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