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Crisis Center Coding & Billing

  1. Default Crisis Center Coding & Billing
    Medical Coding Books
    Our crisis center is adjacent to the hospital emergency department. After the ED doctor examines a patient he/she feels is in crisis and in need of immediate psychiatric care, the patient is referred to our psychiatrist at the crisis center.

    Prior to being examined by the psychiatrist, the patient is seen by the clinical social worker. Can the clinical social worker's bill be submitted and paid by Medicare and/or private insurances? If so, what codes would you use?

    Thanks. I'm new to behavioral health and appreciate your help.

  2. #2
    Just so that I am clear, is the place of service outpatient or inpatient on the social worker?

    They can bill outpatient services, but can not bill inpatient. What does the SW do before the MD sees them?

  3. Default
    The place of service is out patient.

  4. #4
    The way I am understanding this is your crisis center is outpatient and basically functions like a clinic. If that is the case, your social worker may see patients before the psychiatrist. They are 2 different disciplines so it should not be an issue. The SW can bill the new patient eval 90801 or 90802, they can bill regular psychotherapy codes (90804,6,10,12 etc) and they can bill the group therapy codes. The thing is if SW bills therapy codes, then the psychiatrist can not. He would have to be doing med management or bill EM's.
    I would suggest you read this policy and see if this helps:

    This is from WPS Medicare (I am in WI) If you are not with WPS, it may be different but this may help give you some idea.

  5. Default
    I spoke with the Licensed Certified Social Worker yesterday to get the details. I was told the LCSW performs a diagnostic evaluation. This includes a psychiatric evaluation and a traditional mental health status exam.
    The LCSW consults with the psychiatrist and presents all data.

    Hopefully, this will help you. If you need additional info, please let me know.

  6. #6
    Sounds to me like she is doing a 90801 which is a Psych Evaluation. The 90801 needs to have the following documented:
    Complete past family and social hisotry including psych hx
    Mental status exam
    Tentative initial dx
    Evaluation of pt's ability and capacity to respond to treatment
    Also highly recommend stating time spent even though its not required.

    She should bill this and the psychiatrist should be able to bill his service. I am assuming he will be doing some sort of therapy?

  7. Default
    Thanks for the info regarding the LCSW. The psychiatrist will be doing his own evaluation. Since the patient was referred from the hospital ER, we have been instructed by Medicare to use consultation codes, such as 99241.

    I just wasn't sure how to bill the LCSW, if we could bill at all.

    We'll give it a try. If you have any other suggestions, please let me know.


  8. #8
    I would be VERY careful about using a 99241 code. That is a consult and the intent of a consult is asking for an opinion on patient. Is ER really looking for an opinion on the patient or is ER just referring to psych because they know pt needs psych help.

  9. Default
    The ER refers the patient to the Crisis center for an opinion. This could be a committment to a psych hospital, follow up at an outpatient clinic or sent home. A report is given to the ER from the crisis center and placed in the patient's chart.

    There are also times when the patient is taken to the ER by the police, seen in the ER and referred to the crisis center for evaluation. The crisis center physician evaluates the patient and gives an opinion as to the proper
    disposition of the patient.

    What do you think?

  10. Default
    I dont think that the ER is truely looking for an opinion. I think that the ER is actually referring the patient over to the psych and expecting them to take over care. Do you know if there is a transfer of care?

    Do you have a contact to your local Medicare? You might want to run this by them to be sure, but I am not convinced ER wants an opinion as normally the ER just treats and releases. People dont normally continue care from ER. ER refers them to whereever they need to go (psych, family provider, etc) and that provider follows the patient for the issue.

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