Wiki Limits on billing 90801

[iholcomb]

Hello all,

I have a provider (LCSW) that bills 90801 not only for his initial evaluation but on a continual basis instead of 90806 for his counseling sessions. I have looked everywhere possible and have not found an answer as of yet whether this is allowable or not. My thinking is that he should bill 90801 for the initial assessment and then 90806 for his counseling sessions. If there is a break in counseling for a period of time, he may then bill 90801 again to get an assessment and then 90806 for the counseling sessions.
An example of his billing is :
07/03/09 90801
07/10/09 90801 just counseling according to documentation
07/17/09 90801 just counseling according to documentation
07/24/09 90806 just counseling according to documentation
07/31/09 90801 just counseling according to documentation

Does anyone have any input on this kind of billing??

Any help is appreciated!

 

[1073358]

That is absolutely NOT appropriate billing. The code desciption is psych diagnostic interview exam.

You are correct in thinking he should be using a 9080_ for ongoing care, or even a few other codes such as 90846,90847 etc. He can not bill anything with EM component in it though (90805,7...)

Take a look at the claims if he doesn't believe you. I am willing to bet the the subsequents are all denied and if they aren't, they will be soon once they catch the error.