Primary Care Coding Alert

Question: An ob-gyn referred a patient to my family physician for a psychiatric evaluation. Should I report 99245 or 90801?

California Subscriber

Answer: You should choose the code based on the intent of the consultation and the extent of the services rendered and documented. Consultation for psychiatric evaluation (90801, Psychiatric diagnostic interview examination) includes examining the patient and exchanging information with the requesting physician and other informants such as nurses or family members and preparing a written report. Code 99245 (Office consultation for a new or established patient)describes initial evaluation only and does not involve psychiatric treatment.

To report 99245, the ob-gyn must request your FP's opinion, and you should make sure that your family physician (FP) performs and documents the three consultation requirements. Your doctor must examine the patient and report his findings in writing to the ob-gyn. If the ob-gyn truly "referred" the patient to your FP, who will now assume primary care, you should report a problem-oriented office visit (99201-99215, Office visit for a new or established patient) rather than a consultation.

In contrast, if your FP performs a complete mental status examination, you should report 90801. If his or her documentation supports a psychiatric diagnostic or evaluative interview procedure that includes a history, mental status and a disposition and possibly communication with family or other sources, ordering and medical interpretation of laboratory or other medical diagnostic studies it would qualify for 90801.