Pulmonology Coding 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 (90801, 90804, 90806 and 96101)? Kentucky Subscriber Answer: Ignore the sleep part and treat the provider as a psychologist. He is using psychiatric therapeutic procedure codes (except the last one). An auditor would look for the psychiatric criteria for performing those procedures and testing including: • 90801 -- Psychiatric diagnostic interview examination • 90804 -- Individual psychotherapy, insight-oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient • 90806 -- Individual psychotherapy, insight-oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient • 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 with the patient and time interpreting test results and preparing the report. Check Medicare policies for information and guidelines on coding psychology services. Depending on what type of provider he is, here is one type of policy to look at from Medicare for these codes: www.wpsic.com/medicare/policies/wisconsin/psych002.pdf. Don't overlook: Psychologists can perform some E/M services under their state scope of practice. Most psychology services are covered under the behavioral health portion of the patient's insurance (if available). Insurers reimburse these services often at a lower rate than medical services, and payment varies by plan.