ED Coding and Reimbursement Alert

Since your emergency department (ED) physician probably performs several psychiatric evaluations a day, you may need to freshen up on your psychiatric coding lingo if you can't tell when to bill a 99285 versus a 90801. 

Psychiatric visits in the ED are common, and their parameters can vary greatly. Since there is a large difference in services provided to an acutely suicidal or psychotic patient and a patient with a less severe psychiatric episode, coding can often become complicated. The key to coding various scenarios is in the documentation of services provided, which will increase with the severity of the patient's problem. Also, you need to know when to bill the psychiatric instead of the E/M codes. Psychiatric Codes Need Meticulous Documentation
 
The psych series of outpatient codes (90801-90809) has a unique function, independent of the typical medical E/M services, says James Blakeman, senior vice president of Healthcare Business Resources in Bala Cynwyd, Pa. "These codes are specifically for 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," he says.

Emergency physicians provide psychiatric patients with directive and supportive counseling in very limited ways, such as calming patients, reassuring them of their safety, and offering thoughts as to explain their experience, Blakeman says.

Although ED coders rarely use the psych 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), these codes do not have a "place of service" restriction. You can use them in the ED with careful documentation and under appropriate circumstances described above. These psych codes 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 carriers do not deem the interview as medically necessary for patients with a previously established organic brain disorder unless there has been an acute or marked change in status. Also, the physician should conduct the interview only once at the outset of an illness, such as when the patient presents in the ED for the first time. The physician can only perform it again if the patient undergoes an extended hiatus from treatment or requires admission to inpatient status.

Make sure to support medical necessity with ICD-9 codes from the Mental Disorders series (290.0-318.1), such as 295.02 (Schizophrenic disorders, simple type, chronic).
 
Use 99285 for Severe Psych Cases Your best bet is to code most regular psychiatric ED visits using the appropriate E/M code (99281-99285). Kim Myers, CCS-P, CPC, president of Emergency Billing Services Inc. in [...]