Psychiatry Coding & Reimbursement Alert

Question: I want to audit our new sleep behavioral psychologist charts. How different is auditing his charts from physician auditing? Where can I find guidelines for sleep behavioral therapy (90791, 90832, 90834 and 96101)?

Michigan Subscriber

Answer: Ignore the sleep part and treat the provider as a psychologist. He is using psychiatric diagnostic and therapeutic procedure codes (except the last one, which represents psychological testing). An auditor would look for the psychiatric criteria for performing those procedures and testing including:

• 90791 -- Psychiatric diagnostic evaluation
• 90832 -- Psychotherapy, 30 minutes with patient and/or family member
• 90834 -- Psychotherapy, 45 minutes with patient and/or family member
• 96101 -- Psychological testing (includes psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, e.g., MMPI, Rorschach, WAIS), per hour of the psychologist’s or physician’s time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report.

Check Medicare and other payer policies for information and guidelines on coding psychology services. 

Don’t overlook: Most psychology services are covered under the behavioral health portion of the patient’s insurance (if available). Insurers may reimburse these services at a lower rate than medical services, and payment varies by plan.

You can check for information from local coverage determinations (LCDs) of your state at http://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=30489&ContrId=267 for psychiatry related codes and http://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=31990&ContrId=267 for information on psychological testing. You can also look at this Medicare Learning Network article at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Mental_Health_Services_ICN903195.pdf for more information. Finally, if the psychologist belongs to a professional association, such as the American Psychological Association, you may want to consult their web site (https://www.apa.org/) for any relevant information or auditing guidelines they may have for their members.