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90801 time constraints

  1. Default 90801 time constraints
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    We usually spend at least 2 hours with the patient for this service. Are there any modifiers that can be added to increase our reimbursement? Occasionally, depending on ins coverage we will split this into two 1 hour appts but that isn't ideal. How are other folks working around this?

  2. #2
    Location
    Louisville, KY
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    1,101
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    Time is not a factor with this CPT code. Therefore, if the provider spends 45 minutes, we code 90801 or if the provider spends 2 hours with the patient, same code.

    I do not know what other methods have been employed, but I cannot find evidence or support to appending modifiers to a code for which no time is associated; it doesn't seem logical that time is a factor for this code--AMA certainly didn't lay it out that way in CPT.

  3. Default 90801
    Here is some guidance I found helpful.

    CPT code 90801, Psychiatric diagnostic interview examination:
    This procedure is described as the elicitation of a complete history, establishment of tentative diagnosis, and an evaluation of the patientÕs ability and willingness to work to solve the patientÕs mental problem.
    Medicare may cover this service only once per patient at the onset of each new illness, suspected illness, or a new episode of an illness.
    An evaluation and management (E&M) service may be substituted for he initial interview procedure, including consultation codes (CPT 99241-99263), provided required elements of the E&M service billed are fulfilled. Consultation services require, in addition to the interview and examination, the provision of a written opinion and/or advice. Consultation codes do not include psychiatric treatment.

    Using the E&M codes will also allow you to use the prolonged add-on codes when needed You will need to make sure the E&M documentation guidelines are met when determining the level, but it will offer you more flexibility in billing for what actually happened

    Melanie

  4. #4
    Location
    Columbia, MO
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    13,253
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    However E&M codes may not be used for PHds or Masters level therapists.

    Debra A. Mitchell, MSPH, CPC-H

  5. Default 90801
    If they are billing incident to, the E&M codes may be used. I would rather provide all the options and let the questioner select what is specific to their practice rather than assume their situation. She didn't give their credentials. Sometimes I feel that we are most focused on what can't be done. Just my two cents.

    Thanks

  6. #6
    Location
    Columbia, MO
    Posts
    13,253
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    Medical Billing
    Not focused on what cannot be done, just a word of caution being offered. Also I have never read that therapist can bill incident to, I would be very interested in where this information can be found. Also I have always understood that prolonged time cannot be billed incident to, and consultations can never be incident to. Please provide your source for this information as I need it to update some material.

    Debra A. Mitchell, MSPH, CPC-H

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