Psych Eval

NESmith

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If a patient has not been seen in awhile and comes back to see the provder, can the provider bill for a "New" Psych eval or is it like an E/M every three years? I am new to Behavioral Health Services. Thanks for your help in this matter.
 

kevbshields

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Louisville, KY
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How long is awhile and has the patient's condition changed substantially since last time?

Also, we'd need to discuss the payer's policy on psych evaluations.
 

NESmith

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Months and I am not sure if their condition has changed. Patient has been non-compliant with visits and provider feels he can do another Evaluation after the patient chooses to come back. Commerical insurance. Thanks for you reply.
 

MJ4ever

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Temple, TX
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Hi NE Smith,

I just looked up a link for Psych coding on trailblazer local coverage determination.

Mental health services are billed by procedure codes, not E&M codes so there are no new or established codes like in E&Ms.

The initial assessment is 90801 and f/u or psychotherapy codes are 90804-9 depending on the provider type.

Check out this link:
http://www.trailblazerhealth.com/Tools/LCDs.aspx?ID=2870

Per medicare you are only allowed to bill 3 90801s per year.

To bill a 90801 after the first initial assessment, the patient would have to be assessed for a new/different dx than during the first initial assessment.

Hope this helps :)
 
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