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consultation services

  1. Question consultation services
    Medical Coding Books
    According to the 2011 CPT Codebook, the guidelines for Psychiatry state as follows….
    >Consultation for psychiatric evaluation of a patient includes examination of a patient and exchange of information with the primary physician and other informants such as nurses or family members, and preparation of a report. These consultation services (99241-99255) are limited to initial evaluation and do not involve psychiatric treatment.

    Does this mean on the "initial evaluation" the Dr can code a consult code 99242 along with 90801 psyciatric diagnostic interview examination on the same visit?

    To take that one step further if the patient has Medicare the Dr would have to code an E&M instead of the consult code, would this be appropriate?

    This is a qualified "non physician" clinical psychologist.
    Last edited by ALEISHAB; 12-17-2010 at 05:02 PM.

  2. #2
    Jefferson City, MO
    Default billing 90801 and consult
    Per regulations, a psychologist would not be able to bill an E/M code regardless of what is documented.

    For a psychiatrist, it would be one or the other code, not both in my understanding.

    My local carrier, WPS, also puts out billing and coding guidelines in which it states: Psychiatric Diagnostic Interview Examination (CPT code 90801):
    An E/M service may be substituted for the initial interview procedure, including consultation CPT codes, (CPT codes 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. E/M CPT codes do not include a psychotherapy service.

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