Successfully Code for Psychiatric Services
Proper reimbursement from payers requires accurate coding. That means staying current on all updates and using procedure and diagnostic codes accurately.
Busy physicians often code what they are used to coding. However, they can achieve a reduction in denied claims and additional revenue for their practice or hospital if they stay up-to-date on the latest codes—and perhaps more important, learn about codes they aren't using but should.
Here are five services (and how to bill them correctly) that psychiatrists often overlook.
Use the Psychiatric Diagnostic Interview for an Evaluation and Reevaluation
There are two codes for reporting psychiatric diagnostic evaluation: one with medical services for use by psychiatrists, psychiatric nurse practitioners, and psychiatric physician assistants; and another for an evaluation without medical services for use by social workers, psychologists, and other licensed therapists.
The Current Procedural Terminology (CPT) book defines this service as "an integrated biopsychosocial and medical assessment, including history, mental status, other physical examination elements as indicated, and recommendations. This evaluation may include communication with family or other sources, prescription of medications, and review and ordering of laboratory or other diagnostic studies."
The CPT book also states that these codes may be used in lieu of seeing the patient if information needs to be obtained from family members, guardians, or significant others. According to CPT, this code may be billed more than once, although not more than once per calendar day, if the patient is seen on one day and a family member or other party is interviewed on another day. In that case, both evaluations can be reported as if provided to the patient.
There is no time limit about the frequency of reporting the psychiatric diagnostic evaluation. It is not defined as an initial service or a service to a new patient. If there is a break in treatment, or if a patient needs a new evaluation after a hospitalization, it may be billed again. It may not be billed on the same day as psychotherapy in crisis codes. And although the CPT book does not prohibit billing it on the day of psychotherapy, it would be highly unusual for a payer to pay for both a diagnostic evaluation and psychotherapy on the same day.
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Cite this: Betsy Nicoletti. 5 Services Psychiatrists Forget to Bill For - Medscape - Jan 15, 2019.