Coding Corner: Play It Safe When Coding Psych Evaluations

E/M codes may work double shifts

Just because a patient presents in the emergency department (ED) with a psychological complaint doesn't mean you should report your staff's services with psych codes - an evaluation and management code can often do the job. And watching out for giveaway terms like "medication refill," "just needed to talk," "hearing voices," and "suicidal" will help you interpret ambiguous documentation correctly and determine the appropriate E/M level.
The staff in your ED most likely handles psychiatric patients several times each day, and the scope of these services can vary greatly. The large difference between services provided to an acutely suicidal or psychotic patient and a patient with, for example, less severe psychiatric symptoms can make coding complicated. Your key tools: specific documentation of services and knowing when to report psychiatric codes rather than evaluation and management codes.
Don't Just Make a Mental Note
Average medical E/M services and outpatient psych workups are far from the same, says James Blakeman, senior vice president of Healthcare Business Resources in Bala Cynwyd, Pa. The psych codes (90801-90809), he reminds us, specifically designate "psychotherapy, a talk-therapy discipline involving evocation of insight, behavior modification, and a variety of other approaches to secure an improvement in the patient's psychiatric condition."
ED physicians generally provide psychiatric patients with directive and supportive counseling - such as calming patients, reassuring them of their safety, and offering thoughts to help make sense of their experience, Blakeman says. But this support is usually limited, so be careful to read the documentation carefully when deciding whether your staff's service really warrants psych codes.
You should note that codes 90801 (Psychiatric diagnostic interview examination) and 90802 (Interactive psychiatric diagnostic interview examination using play equipment, physical devices, language interpreter, or other mechanisms of communication) require the presence of a psychiatric diagnostic or an evaluative interview that includes history, mental status and disposition, communication with family or other sources, and ordering and interpretation of laboratory or other medical diagnostic studies.
Most intermediaries don't consider the interview medically necessary for patients with previously established organic brain disorders unless they've had an acute or marked change in status. Also, the physician should conduct the interview only once at the onset of an illness, such as when the patient presents in the ED for the first time.
 
Report 99285 for Severe Cases
Your best bet is to code most regular psychiatric ED visits using the appropriate E/M code (99281-99285), says Kim Myers, CCS-P, CPC, president of Emergency Billing Services Inc. in Lake Milton, Ohio. She explains that the level of service required to report 90801 (or 90802, an interactive interview) is about equal to a level-five [...]

- Published on 2003-10-06