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Triage encounter

  1. #1
    Default Triage encounter
    Medical Coding Books
    I am a coder at a US Army base. I just recently began coding behavioral health visits. I mainly code children and adolescent services, but have started assisting another coder with her backlog in an adult clinic. Due to the large number of service members (SM) needing behavioral health services, this clinic has implemented a Triage encounter. This is the first encounter the SM has with the clinic, and the provider is seeing him/her to determine if they will be seen on-post or off-post. The provider gets a history from the SM and sometimes will give them a psych test. If the SM is to be seen on-post, an Initial Intake visit is scheduled. These visits have been coded according to the time spent with the patient (90804, 90806, etc), however I don't think this is correct as everything that's being done at this Triage is encompassed in the 90801 code (except, perhaps, the psych test - 96101). I don't see how the providers can get credit for this visit. Does anyone have any insight as to how this can be coded? Is it even possible to give this visit a code? All comments are welcome! Thanks so much!

  2. #2
    Nashville AAPC Chapter
    I would be leary of using the 90804/05 codes if no actual psychotherapy was not done in triage. The appropriate code for the work that was done is the 90801. Good work.

  3. #3
    Quote Originally Posted by mworcester View Post
    I would be leary of using the 90804/05 codes if no actual psychotherapy was not done in triage. The appropriate code for the work that was done is the 90801. Good work.
    Thanks for your response. My next question would be: IF counseling is being done and documented during this Triage visit, but the visit doesn't meet the requirements for an initial diagnostic interview (90801), can you code a 90804, 90806, etc? Would a third-party insurer question if you billed a 90804 for the patient's first visit, then billed the second visit as a 90801?

  4. #4
    I am not aware of military insurance but most insurance will not deny a claim. The services are based on time and if the psychiatrist only saw the client for a half an hour or less then 90805. I used 90804 and 90806 for therapists and 90805 and 90807 for psychiatrist.

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