Extended Visits for 90801

RadioFlyer80

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Hi there,

Some of our providers have to use additional visits in order to complete the psychiatric eval 90801. In situations that exceed more than one visit to accomplish the eval, is it justified to add a modifer 22 to 90801? Or, should they only get a 90801 for all of their work?

Thanks!
 

kevbshields

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The problem is that 90801 is not a time based code, meaning that additional time is not necessarily part of the equation. However, you could rationalize that additional effort and provider skill is needed in order to accomplish the service. Consider, though, that appending Modifier 22 will automatically require that you send the record to the payer along with the claim in order for it to be adjudicated. The time and effort your staff puts into that may not be ample return on investment. Some payers will not recognize the modifier 22, so I am told, so that may be something to consider, as well.

While those who've worked with behavioral health know that this particular code and its service are problematic from a cost-recovery perspective, because there is not "standard" time associated with 90801, there isn't a solid logic for arguing that your provider used "extenuating" time to complete the evaluation.

Depending on the provider who is furnishing the service (MD, psychologist or LCSW), you may or may not be able to capture extended services (out of the E&M section) for additional time spent.
 
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