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Thread: 2nd psych opinion in NH?

  1. #1
    Join Date
    Apr 2007
    Grand Rapids, MI

    Question 2nd psych opinion in NH?

    AAPC: Back to School
    I originally posted this in the Behavioral Health category with no help. Hopefully someone in the general discussion group has an answer...

    I have an MD who does occassional second opinions on nursing home patients when there is a concern about the patients ability to make responsible medical decisions for themselves. There is a very limited ROS and Exam, mostly all psych eval. Since my doc is doing the second opinion, he is also reviewing the initial physicians records.

    What code should I use? An initial nursing visit doesn't sound appropriate - but maybe?


    KLB, CPC
    "Sucess is not final, failure is not fatal; it is the courage to continue that counts." Winston Churchill

  2. #2

    Default RE: 2nd opinion in NH?

    Hi klbrown1,

    Is your doctor a psychiatrist?? I bill for a psychiatrist who is often referred to NH's for the reason you mentioned and does mostly a psych evaluation w limited ROS and reviews the PCP's records. If it is primarily a psych evaluation and as long as you're using psych dx, 90801 would be the best fit. Most insurances recognize this code including Medicare and Medicare Advantage plans (check your local Medicare LCD for list of covered dx's). When I run into an insurance that does not recognize 90801, I bill a 99253. I live in PA and one of the only insurances that does not accept it is Medicaid.

    Hope this helps!


  3. #3
    Join Date
    Apr 2007
    Grand Rapids, MI


    Thank you for your reply,

    My Dr is not a psychiatrist. He is internal medicine. Can I still use the 90801? I want to stay away from the 99253 because most of my patients are Medicare.
    KLB, CPC
    "Sucess is not final, failure is not fatal; it is the courage to continue that counts." Winston Churchill

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