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Psychiatrist billing subsequent hospital care

  1. #1
    Question Psychiatrist billing subsequent hospital care
    Medical Coding Books
    A Psychiatrist is billing for Subsequent Hospital Care (99231-99232) in a inpatient pos 51 or 56. This doesn't seem like the most appropriate code to bill for the services being provided. The services are mental health related and not medical health related. Seems to me like the codes should be 90816-90829 depending on time spent. There also is no initial hospital care, the psychiatrist is billing a 90801 Psychiatric diagnostic interview examination. Anyone have any wisdom to add to this?
    Jennifer Tucker CPC

  2. #2
    Louisville, KY
    Nothing wrong with it if those codes are appropriate. If you can score it to 99231-3, then I do not see the problem. Psychiatrists are physicians . . . therefore, E/M services are appropriate.

    Often visits in the hospital may not quite qualify for the 90816 series, because no psychotherapy is done.

    Can you explain why you say, "This doesn't seem like the most appropriate code to bill for the services being provided?" Although the nature of psychiatry is a tad different, that does not in and of itself preclude another code set.

  3. #3
    There is no medical involved with this visit. It is all psyc based. No, physical evaluation, all mental evaluation. That's why I say it doesn't seem like the correct codes to use.

  4. #4
    Louisville, KY
    Have you seen the 1997 Exam guidelines for Psych services? Mental health examination is a form of medical evaluation. E/M codes do not require a provider perform a "typical medical" exam. These codes fluidity permits practioners to perform an exam that is consistent with the patient's clinical manifestations. We would not expect psychiatrists to perform a comprehensive physical examination of the patient in lieu of mental status exam the same way we would not expect a cardiac surgeon to perform a full mental status exam but no physical exam.

    Does that make sense?

    If your note ends up with a History, Exam and Medical decision making, there is no reason to fear using the e/m codes. The psych codes you mention would require evidence of psychotherapy for their appropriate use. An absence of psychotherapy during the face-to-face encounter requires you utilize the subsequent hospital visit codes.

    Hope this helps.

  5. #5
    What would constitue and absence of psychotherapy? In addition I don't see a complexity of Medical Decision making in the therapy notes provided.
    So, I am really struggeling to grasp how they fit into an E/M category. The notes look just like any other psyc therapy note I have read. Nothing different except it's inpatient and the provider is a Psychiatrist, MD.

  6. #6
    Louisville, KY
    Psychotherapy is a form of treatment for mental illness, psychosocial factors, etc. In most of the cases I've seen, psychotherapy is mentioned by the provider--or it is in some way evident that psychotherapy was performed.

    MSE (mental status examination) is not the same as psychotherapy. MSE is equivalent to the physical exam most coders are familiar with physicians performing.

    The best way, if psychotherapy is in question, is to query the provider for clarification. As an aside, in the acute care environment, it's very unusual to find psychiatrists offering psychotherapy. Normally that is relegated to ancillary staff.

    As for MDM, it isn't usually going to have factors like MRIs and EKGs; you will see mention of advising the patient to participate in groups (med section), pharmacological management, recommending intervention by social work and referring the patient for pysch measurements or tests.

    Hope this is of assistance to you. Sound like the provider may have the info you're seeking.

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