Preliminary meeting with parents

dbut

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Dr. is seeing parents of identified patient (child) before meeting with the child himself. The notes written, including an assumed diagnosis, are about the child. Can 90801 be billed again when the encounter is with the identified patient himself? If not how can 90806 be billed for the child as his first encounter. This occurs regularly here and we are trying to clarify the best way to go about this.
 

1073358

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I would question why he needs to spend the entire session with the parents alone. Our child psych MD meets with parents and kid to do the 90801, since most of it is gaining history. He might talk breifly with parents alone, then have kid come in
 

dbut

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being that we are an FQHC, our psychologist, therapists, etc feel that this is the most effective way to go about meeting with the child eventually. This being the case how would we code the various meetings.
 

1073358

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In all honestly, I am not sure it would be approriate to bill the parent visit and the child's first visit both. I think obtaining info from the patient in included in the 90801/90802.
If you were to bill, you could maybe bill an EM for parent visit and then bill a 90801/2 for child. But once again, I question the medical necessity. The 90801/2 requires a mental status exam to bill, so you can't use that for meeting with parents. I was thinking maybe you could bill the 90846 for parents and then the 90801/2. That might be a possibility. Without him seeing the patient though, I don't know how he can really dx either.
 

deyoung

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For the parent visit I would look into using either an E/M code or 90846 and maybe a V code for the Dx. With E/M, if basing the level selection on time, it does state in the CPT that the time spent is with the patient and/or family.
 

1073358

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I originally thought 90846 as well, but does it make sense? Insurance will see the very first DOS as the 90846 apt. Then maybe a few days later, she will bill the 90801 which is the psych eval. In my mind I would think billing a therapy apt before the psych eval would be somewhat of a red flag wouldn't it?
 

kevbshields

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All detailed services mentioned fall into the 90801--which should be coded/billed on the DOS the face-to-face encounter took place with the actual patient.

90801 services may occur over several days. Gaining collateral information is included in that code descriptor. No separately identifiable service has been rendered to the parents, nor to the patient yet. Therefore, all those services--regardless--fall under the auspices of 90801.

Good luck.
 

mitchellde

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I agree with Kevin everything you have stated is part and parcel of the the 90801, there really is nothing else that can be billed
 

dbut

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so even though it's being coded on a few encounters, coding 90801 is okay to code over several days? is there a time frame for the second meeting with the child himself?
 

1073358

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The "typical" time of a 90801 seems to be about 60 minutes. But technically there is no time limit
 
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