It's been nearly 10 years since I billed psychotherapy codes, but I think you might run into a medical necessity situation by billing the infant's insurance. Think about it: How many babies are in psychotherapy? I believe you should be billing the parent's insurance for these services; they are the ones who are receiving the assessment and counseling. The diagnostic interview would be appropriate for the first meeting, followed by the time based counseling codes. (you probably already know that) I'd use V61.49 if the psychologist could not provide an DSM-IV code after the appointment (such as adjustment disorder, or whatever), but I'm not sure about coverage issues with a V-code (depends on payer). Usually I'd wait to bill until the diagnosis had been provided by the psychologist.
That having been said, CMS does discuss the need for third-party counseling for sick or incapacitated recipients, during which time the provider can request a meeting for the family or caregivers to discuss the needs of the patient. That's the caveat: the discussion has to be about the patient's needs, not about the issues that arise for the caregivers. So I think that you're best to bill the parent's insurance in your case. Can you please keep me posted? This is an interesting topic. Thanks, Pam
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