# Medical Eval for a Psych Admit



## ksrodgers (Jun 6, 2013)

I do the professional coding for hospitalists who do the H&P for all patients admitted to a psych unit of our hospital. By law, a medical exam must be done within 24 hours of admission. There is not always an active medical issue for the hospitalist to treat, so they end up using the behavioral health diags for the primary diag. Obviously, the psych providers are the ones treating the psych issues, not the hospitalist. So if there are no medical issues, but it's mandatory to do the medical exam, what diag should be used?

We tried V70.2, but that gets denied by any insurance that uses a separate vendor to administer the psych benefits. Obviously the hospitalist can't be contracted with the psych vendor. 

What diag do you recommend?


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## erjones147 (Jun 6, 2013)

Would V70.4 work (exam for medicolegal reasons)?


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## ksrodgers (Jun 7, 2013)

I think that would also kick out because it is a V-code, but it's worth a shot. It's certainly better than V70.2.


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## Pam Brooks (Jun 7, 2013)

Wouldn't the psychiatrist be the attending who is responsible for the H&P? Your hospitalist in this case would be acting as a consultant....to evaluate the patient for chronic medical illnesses, and only after the psychiatrist did the H&P to request the consult. What you have is a situation common (and tricky) with hospitalists where they're used regardless of medical necessity to see the patient as a standing order. A standing order does not constitute medical necessity, which you have already identified by saying that there is no diag other than the mental health diag. These would not be billable services.


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## tbolla (Jun 10, 2013)

I'm also working with a group that performs the same services. They are a family medicine group. In our case, the Psychiatrist is not performing the H&P within the 24 hours required so the family medicine group is called in. 

One of the biggest challenges for this group is also identifying the appropriate dx code for the visit. Secondly, the claims are often denied when sent to the medical plan because of the POS 51 on the claim. 

I am trying to find the most appropriate way to handle these claims as well. It's definitely tricky!


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## kyinai7 (Jun 10, 2013)

*New*

In coding introduction study for one of the Inpatient guide lines to assign principal dx is   "Uncertain diagnosis at the time of discharge, code condition if it existed or established (arrangement for further workup or observation, initial therapeutic approach) . It is applicable to IP admission to short-term, acute, long-time care, psychiatric hosp."

   If you might consider this point, would it be helpful?


Kyi Kyi Naing
CPC-A


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## mitchellde (Jun 10, 2013)

kyinai7 said:


> In coding introduction study for one of the Inpatient guide lines to assign principal dx is   "Uncertain diagnosis at the time of discharge, code condition if it existed or established (arrangement for further workup or observation, initial therapeutic approach) . It is applicable to IP admission to short-term, acute, long-time care, psychiatric hosp."
> 
> If you might consider this point, would it be helpful?
> 
> ...


This guideline applies only to the facility coder not the physician coder.  Also only if the provider documents a diagnosis as possible, probable, suspected or rule out.  Tocode for an admission to a psych hospital or unit, you would use the psych diagnosis that the patient is being admitted for.  You cannot code anything else.  It is not an exam for medicolegal issues unless this is court ordered admit.  The reason the patient it there is a psych diagnosis.  If the law requires a medical exam then use your 32 modifier on the exam code to indicate mandated service, but be absolutely certain this is a legal requirement and not a hospital policy.


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## tbolla (Jul 24, 2013)

I've found very little information on the use of the 32 modifier. The exam is definitely mandated by law/legislature so it does seem appropriate. 

Debra: can you tell me if you have used this modifier in the past and have you been successful?


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## ksrodgers (Jul 25, 2013)

mitchellde said:


> This guideline applies only to the facility coder not the physician coder.  Also only if the provider documents a diagnosis as possible, probable, suspected or rule out.  Tocode for an admission to a psych hospital or unit, you would use the psych diagnosis that the patient is being admitted for.  You cannot code anything else.  It is not an exam for medicolegal issues unless this is court ordered admit.  The reason the patient it there is a psych diagnosis.  If the law requires a medical exam then use your 32 modifier on the exam code to indicate mandated service, but be absolutely certain this is a legal requirement and not a hospital policy.



While the patient is being admitted to the psych unit for the psych diag, the hospitalist is NOT the one diagnosing the psych issue, or treating the diagnosis for that matter. I don't see how you can legitimately code that psych diagnosis if the hospitalist is not ACTIVELY treating it.


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