Wiki Spinal Cord Stimulator Psych Eval?

[aweaver74]

Can a pain management provider bill for a 90791 psych eval for the spinal cord stimulator? This is something new that his staff has started billing and I cannot see how a pain management doc is qualified to do a psych eval. I would think the provider would have to refer the patient to a psychiatrist for this evaluation. Any guidance is greatly appreciated.

 

[karras]

We have a clinical psychologist who performs these psych evals prior to SCS placement.

 

[dwaldman]

I believe if you look at the local coverage determination policy for Medicare carrier you are billing for the CPT code in question, there will be reference to who can actually perform this service:
For example, describing "within their scope of practice" from WPS Medicare J5. Typically this service is reserved for someone who are specialized in the field of diagnosis/treatment of mental disorders.

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Coverage Indications, Limitations, and/or Medical Necessity

Psychiatry and Psychology are specialized fields for the diagnosis and treatment of various mental health disorders and/or diseases.

References to providers throughout this policy include physicians, and non-physicians, such as clinical psychologists, independent psychologist, nurse practitioners, clinical nurse specialists and physician assistants when the services performed are within the scope of their clinical practice/education and authorized under the state law.

 

[aweaver74]

Thank you. You confirmed my thoughts but the practice manager was trying to tell me the physician himself could bill this service.

 

[cubuscrystal]

We have a clinical psychologist who performs these psych evals prior to SCS placement.

Do you still work for the same practice and could possibly help me with something in regards to the psych visit for a scs placement?