Psychiatry Coding & Reimbursement Alert

Published on Mon Oct 03, 2016 PDF

Watch for situations when the evaluation is complicated by communication issues.

When reporting a initial psychiatric diagnostic evaluation for a patient, you will need to determine the right code to report when your psychologist performs the service and whether or not you can report the service if the patient is reevaluated within a span of three years. In addition, you should know the code(s) to report when your clinician encounters communication issues during the evaluation.

Look through the following four scenarios and see if you can crack the coding rules for the different initial psychiatric diagnostic evaluation situations.

Scenario 1: Psychodiagnostic Evaluation by Psychologist

Your psychologist is performing an initial evaluation of a new patient. The patient is suffering from mood swings and problems with concentration. Your clinician obtains a thorough medical and past family history, and the patient says that she is not taking any other medications, nor does anyone in the family have a similar problem. Your clinician also speaks to her mother, who says that the patient’s problems began when her boyfriend of many years died in an accident. What code can be used to report this initial evaluation of the patient?

1) 90791
2) 90792
3) 99203
4) 99213

Scenario 2: Reporting a Follow-up Psychodiagnostic Evaluation

Your psychologist reviews a patient who was under his care for depression a year back. Your clinician was performing psychotherapy for the patient, but he discontinued it after a couple of sessions. The patient’s symptoms were aggravated, and he again consulted your clinician. Your clinician reevaluates the patient. What code do you report for this evaluation of the patient?

1) 90791
2) 90792
3) Established patient E/M code
4) Service within three years cannot be reported separately

Scenario 3: Psychodiagnostic Evaluation With Communication Issues

Your psychologist is performing an initial evaluation of a patient. The service is taking more time and effort as your clinician is experiencing difficulties becausethe patient has communication difficulties. What code(s) do you report for this initial evaluation of the patient?

1) 90791
2) 90792
3) 90791, +90785
4) 90791, +99354

Scenario 4: Psychodiagnostic Evaluation With Pharmacological Management

Your psychologist reviews a 43-year-old male patient who was seen about six months back with complaints of depression. The patient had been on medications but approached your clinician again recently, as the symptoms were getting aggravated. Your clinician performs a reevaluation of the patient. He also reviews the medication that the patient is taking and makes adjustments to the dosage of the medication. What code(s) do you report for the reevaluation and the pharmacological management performed by your psychologist?

1) 90791
2) 90792
3) 90791, +90863
4) Established patient E/M code