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Linda Thomas

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I've been seeing conflicting articles about the acceptance of psychologists reporting consultation codes (99241-99245) for non DSM-3 Dx evaluations. Does anyone know of any commercial payers who do pay for these services.
 
To my knowledge, psychologists cannot code/bill for E/M consultations (99241-99255). Although they render their own version, this is not the correct code set for that purpose. It's unlikely any commercial payers will knowingly remit payment for a provider who isn't properly credentialed to use that code set.

Even if you are receiving payment, I'd clarify with the payers that these were, in fact, the codes they are requesting from Psychologists. I've never known of the payers encouraging the inappropriate use of the consult codes before...but, that isn't to say it doesn't happen.

Good luck.
 
Our department does bill consultations for our PhD's as long as the documentation supports a consult. We also have an MD attending for them that gets billed on the claim as well.
 
psychologists can not bill codes with medical factors (ie 9921_, 9924_, 9925_, and 9920_)

I do not think they should be doing consults.
 
This is a licensing and credentialing issue in that Psychologists carry neither a license nor are they credentialed with payers to perform these services. There are codes--elsewhere in Medicine section--that describe their services. Consultation codes do not.

I have personally witnessed social workers using E/M codes, but that doesn't make it correct. The documentation produced by either of these mental health providers does not warrant an E/M visit code.
 
ritzd

kevbshields said:
This is a licensing and credentialing issue in that Psychologists carry neither a license nor are they credentialed with payers to perform these services. There are codes--elsewhere in Medicine section--that describe their services. Consultation codes do not.

I have personally witnessed social workers using E/M codes, but that doesn't make it correct. The documentation produced by either of these mental health providers does not warrant an E/M visit code.
Click to expand...

Code 96153 , 99078, 90853 Do you think that any of these codes would be appropriate to use for a Psychologist leading a group program for pts with chronic illnesses? Also could a NP run these groups and could she bill incident to for these services?
Thanks
Ritzd
 
Ritzd

Kevin

I am new at this but I have a question in regards to this Psychology issue.
Codes 99078,90853 96153 Can any of these codes be used for a group session for chronically ill patients ( such as DM, Hpertension) conducted by a psychologist? Also could a NP run this session and be billed as incident to the psychologist? Does Medicare have any type of limits on these codes as to how many units can be billed daily or yearly? I do appreciate your help with this perplexing issue.

Thanks
Ritzd:( :(
 
There would be no need for the NP to be billed incident to the PsyD/PhD. It is generally within the scope of practice for an NP to carry out these tasks.

96153, I'd expect an NP to do this. Not so sure about the Psychologist. Check the CMS website RE: a psychologist's use of this code. From my perspective, that'd be unusual.

99078, again, within the scope of the NP, but probably not the psychologist. The psychologist has other options for group therapy/education codes that are recognized within his/her scope.

90853 is appropriate for either psychologist or NP.

I hope this helps. Noridian has some excellent information on the appropriate code assignments for each provider type. I definitely recommend looking into that document.

Good luck!
 
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