Wiki Pediatric Psyd Coding and billing for Mental/Behavioral Health

[katiereynolds]

We just added our first psychologist to our practice and I'll be doing the coding and billing of her claims. We're an outpatient, independent clinic specializing in pediatric care in Wisconsin. The provider's degree is a PsyD.
She'll be performing both diagnostic evaluations for the purpose of diagnosing; and also regular mental health/behavioral health therapy sessions. I've been trying to dig up articles on the diagnostic testing on this and am Just not finding much. I know that I need either an AH or HP modifier. Apparently the way they billed/coded her claims at her old place of employment was something like this for the diagnostic testing/assessment:
90791 for the first hour/parent meeting
96136 for test administration and scoring then +96137 for each additional 30 minutes
96130 for psych testing eval services, first hour
+96131 testing, each additional hour
+90785 for interactive complextiy (if needed)

Then a parent meeting at the end with 90837.
I can't find a whole lot of info on this, maybe I'm looking in the wrong places. Any links to good articles or personal insight is appreciated!

 

[SharonCollachi]

I am guessing this person is a licensed clinical psychologist in your state, so the degree itself doesn't really matter (PsyD vs. PhD).

90791 is the correct code for a psych eval that does not include medical services (as medical services cannot be provided by a psychologist). There is no time associated with this code. This code can be used whether the patient or the parents are in the session. If the patient is not in the session, then unless there is an interpreter present or child abuse to report, you would not use the 90785. Your regular mental health therapy sessions will be with 90832, 90834, 90837, which are all time-based.

For psych testing, there is a great chart on page 726 of my 2020 CPT book that shows all the codes and who can use them, under what circumstances. You'll want to look at that because the test code is going to depend on the purpose of the testing. If it's cognitive performance, that is a different code that developmental screening, and a different code for neurobehavioral.