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sparkles1077

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For a multispecialty clinic, infants are seen in Craniofacial Department to evaluate newly diagnosed cleft lip and palate. Afterwards, the parents and infant talk to the psychologist. The psychologist evaluates the parents stress and reaction to baby with this diagnosis. What psychotherapy code should be used? This is a multispecialty Pediatric clinic, and the baby's insurance is billed.
 
It's been nearly 10 years since I billed psychotherapy codes, but I think you might run into a medical necessity situation by billing the infant's insurance. Think about it: How many babies are in psychotherapy? :) I believe you should be billing the parent's insurance for these services; they are the ones who are receiving the assessment and counseling. The diagnostic interview would be appropriate for the first meeting, followed by the time based counseling codes. (you probably already know that) I'd use V61.49 if the psychologist could not provide an DSM-IV code after the appointment (such as adjustment disorder, or whatever), but I'm not sure about coverage issues with a V-code (depends on payer). Usually I'd wait to bill until the diagnosis had been provided by the psychologist.

That having been said, CMS does discuss the need for third-party counseling for sick or incapacitated recipients, during which time the provider can request a meeting for the family or caregivers to discuss the needs of the patient. That's the caveat: the discussion has to be about the patient's needs, not about the issues that arise for the caregivers. So I think that you're best to bill the parent's insurance in your case. Can you please keep me posted? This is an interesting topic. Thanks, Pam
 
Thank you Pam. Yes, I actually suggested billing the parent's insurance myself, but I am not gaining support for this idea. I guess because we are a Pediatric Hospital and everyone bills the patient's insurance. It makes more sense to me to bill the parent's insurance - it is not like the psychd is talking to the infant or having a significant influence on the infant at this time.

Thank you for your input. Our contractors are working on this issue, so I will let you know what I learn.

Diana
 
Why not build the counseling into the MDM for the infants encounter, and possibly then use prolonged time with the addition dx code for other person seeking consultation on behalf of the patient? (sorry books are not with me at this moment it is a V code in the V68 or V65 catergory). If the child is not present when the counseling takes place then what about the 99358 for prolonged encounter without face to face? I guess I am just not seeing this as a psychotherapy encounter.
 
Psychologists (Ph.D., Psy.D.) cannot bill E&M codes. So MDM will not apply here. As a psychologist, they will do an assessment of the parent's psychological status, the impact of the infant's diagnosis, determine a treatment plan (if appropriate). They are not medical doctors, and thus would code from the 9080X series.
 
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