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Can I bill a 90801 again??

  1. #1
    Default Can I bill a 90801 again??
    Medical Coding Books
    Dr originally sees pt for work problems. Then she goes 3 months without seeing the patient. Patient returns with new complaints of marital problems. Can I bill a 90801 again since its a new issue with a new treatment plan?
    The rule I have on 90801 says this code may be billed once, per provider/discipline, at the onset of an illness or suspected illness. It may be utilized again for the same pt if a new episode of illness occurs after a hiatus, or an admission/readmission, to an inpt status due to complications of the underlying condition.

    What exactly do you think if a new episode of illness occurs after a hiatus means? Clarification would be great on this.

  2. #2
    Default
    Psychiatric Diagnostic Interview Examinations (90801, 90802)

    A diagnostic interview may be indicated for an initial or periodic diagnostic evaluation of a patient for suspected of diagnosed psychiatric illness. This service may be covered once, at the onset of illness or suspected illness. However, additional diagnostic interviews may be covered if a new episode of illness occurs after a hiatus, a new inpatient admission or re-admission occurs, or if the evaluation is required in order to address a new question.

    A hiatus is like a break/interruption...

  3. #3
    Default
    It sounds like there was a break in service and this is a new issue so I would say okay to bill as 90801.
    Donna E. Young, CPC

  4. #4
    Default My Take on this....
    Quote Originally Posted by 1073358 View Post
    dr originally sees pt for work problems. Then she goes 3 months without seeing the patient. Patient returns with new complaints of marital problems. Can i bill a 90801 again since its a new issue with a new treatment plan?
    The rule i have on 90801 says this code may be billed once, per provider/discipline, at the onset of an illness or suspected illness. It may be utilized again for the same pt if a new episode of illness occurs after a hiatus, or an admission/readmission, to an inpt status due to complications of the underlying condition.

    What exactly do you think if a new episode of illness occurs after a hiatus means? Clarification would be great on this.
    per the e&m section, where 90801 and 90806 falls, only the eval code can be billed once per provider every 3 years. They can go to a different doc to get an 90801 availaible, otherwise the doctor/therapist can only get the established psych therapy codes. Actually, i believe there is a code specific to marraige therapy... Check that out. Hope this helps!!! Pjm

  5. #5
    Default
    Quote Originally Posted by paulmuir View Post
    per the e&m section, where 90801 and 90806 falls, only the eval code can be billed once per provider every 3 years. They can go to a different doc to get an 90801 availaible, otherwise the doctor/therapist can only get the established psych therapy codes. Actually, i believe there is a code specific to marraige therapy... Check that out. Hope this helps!!! Pjm
    I think that the 3 year rule you are referring to is for the EM office visit codes. Psych codes are in medicine section and no where in there does it say 3 years to my knowledge...??

  6. #6
    Default
    I was thinking the same thing about the 3 yr rule and was unable to find that info in the CPT book. Maybe it's a rule specific to that users state? We see primarily inpatients and may bill multiple 90801s for 1 patient within a 3 year period because they may have several admissions within that time.

    Pjm - I may be missing something. Please direct us to where this info is located. I checked the Psychiatry guidelines in the CPT book and was unable to find the 3 yr rule. Thank you.

    For marriage counseling you may be able to use 90847 for conjoint therapy (patient and spouse present).
    Donna E. Young, CPC

  7. #7
    Location
    Louisville, KY
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    1,101
    Default
    I'm away from my resources for travel, but the 3 year applies to 90801 and 90802. This information is a CMS standard, if I'm not mistaken.

    Keep in mind that a full psych is a full-fledged evaluation, not a code or service of exclusion.

  8. #8
    Default
    Is someone has documentation from Medicare on the 3 year rule, please post it for me so I can use as a referrence.

  9. #9
    Location
    GREATER ATLANTA
    Posts
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    Default
    Hi,
    I had a situation with Aetna where they denied our request for authorization for testing by a PhD because the 90801 evaluation (by an MD in our pratice) was 6 months old. After the PhD completed a new evaluation we were granted the authorization for testing.

    I promise this is True!
    Charlene

  10. Default
    I am having a similar problem. Therapist saw client at a one site, saw her for therapy then after 3 months decidided to see her at other site but needed a 90801 to open her to the new site. i checked with her insurancea and yes if they stop coming for 6 months you can do another 90801. my problem however is she was being seen for the full 3 months then he did an intake form to open her to the new site but wants to bill it as a 90806 since we wont get paid for another 90801. does anyone know the rules about this? i say no you cant bill a 90806 when the documentation clearly shows a 90801.
    help please they wont believe me

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