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CPT 90801 Service

  1. #1
    Default CPT 90801 Service
    Medical Coding Books
    I am new to psych coding and I am not sure which way is correct.
    I code for an Emergency Department, which sees patients 24 hours a day.
    For the CPT code 90801 I have the following information:

    "CPT 90801 is a single UN-TIMED service therefore multiple units per date of service are not covered, regardless of the number of professionals involved in the examination process".

    I understand this to me that for one encounter in the ED, it should only be charged once no matter how many clinicians have seen the patient (unless more than 24 hours has passed, then you may charge it twice. For example; patient saw at 4/5 1:00 AM and then if they are still in the ED and patient was seen at 4/6 2:00 AM - I could charge the 90801 service twice). One of my co-workers understands this to mean that if a patient is seen at 4/5 11:58 PM with a service of 90801 and then again at 4/6 12:02, you may charge the 90801 again, because it is a different date of service.

    Can anyone help me with this issue? Thank you.

  2. #2
    Default 90801
    CPT 90801 is used in the psychiatric setting, usually by the psychiatrist at the initial visit. In Wisconsin, the LCD states: CPT code 90801 is described as the elicitation of a complete medical and psychiatric history, a mental status examination, establishment of a tentative initial diagnosis, and an evaluation of the patient's ability and capacity to respond to treatment on an initial plan of treatment." It goes on to state: "This service may be covered once, per provider/discipline, at the outset of an illness or suspected illness. It may be utilized again for the same patient if a new episode of illness occurs..."

  3. Default 90801 in Inpatient setting
    Physicians at our facility sometimes happen to manage a patient in psych ward for an acute illness, but do a complete intake summary and/or diagnostic interview examination only on the second or third day of admission (usually on weekend or late admissions). Can I, in those cases, code other appropriate inpatient codes for the initial days and code the interview examation on the second or third day. In other words, my question is "Are CPTs 90801 and 90802 reserved for initial day of admission or can we use these codes on subsequent days of admission if performed so?"

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