Psychiatry Coding & Reimbursement Alert

Question: Our psychiatrist saw a patient at our hospital and recorded complete history of the patient along with review of systems. The same visit he decided that the patient needed insight oriented behavioral therapy and provided 25 minutes of psychotherapy. Can I code 90801 along with the inpatient psychotherapy codes?

Nevada Subscriber

Answer: When any new patient is seen by your psychiatrist, your psychiatrist will perform an initial evaluation of the patient. This initial interview examination will include a complete mental status examination, complete evaluation of the patient's history, a review of systems, as well as discussions with family members and ordering diagnostic tests with interpretations. A complete mental status examination will include your psychiatrist assessing the patient's:

• recent and remote memory,
• concentration and attention span,
• mood and affect (e.g., depression, anxiety, agitation, hypomania, lability)
• orientation to time, place and person,
• fund of knowledge (e.g., awareness of current events, past history, vocabulary) and
• language(e.g., naming objects, repeating phrases)

Your psychiatrist will perform this service by asking appropriate questions and through examinations. You should report the services rendered by your psychiatrist with 90801 (Psychiatric diagnostic interview examination).

However, in the same session, if your psychiatrist performs psychotherapy, you cannot code 90801 along with psychotherapy codes. As per Correct Coding Initiative (CCI) edits, 90801 is a column 2 code for psychotherapy codes with the modifier '0' which indicates that 90801 cannot be reported along with psychotherapy codes under any circumstances.

So if your psychiatrist performed psychotherapy during the same session, report the appropriate psychotherapy code. Since your psychiatrist performed a thorough evaluation of the patient, you can choose psychotherapy codes with E/M. In this case scenario, you can report the services performed by your psychiatrist with 90817 (Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 20 to 30 minutes face-to-face with the patient; with medical evaluation and management services).